Nedeltchev Krassen, Brekenfeld Caspar, Remonda Luca, Ozdoba Christoph, Do Dai-Do, Arnold Marcel, Mattle Heinrich P, Schroth Gerhard
Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern, Switzerland.
Radiology. 2005 Dec;237(3):1029-37. doi: 10.1148/radiol.2373041537. Epub 2005 Oct 19.
To evaluate retrospectively the outcome for patients with acute ischemic stroke in the territory of the middle cerebral artery (MCA) who had undergone stent implantation in the proximal segment of the internal carotid artery (ICA) in addition to intraarterial thrombolysis (IAT).
Stent implantation and retrospective analysis of clinical and radiologic data were approved by the institutional ethical committee. Endovascular treatment was performed after obtaining informed consent from patients or their closest relatives. Informed consent for retrospective review was not required. After pharmacologic and/or mechanical IAT, 25 consecutive patients (seven women, 18 men; mean age, 59 years +/- 14 [standard deviation]) underwent stent implantation in the proximal segment of the ICA (endovascular group). The clinical and radiologic characteristics (ie, interval from symptom onset to arrival at the emergency department, prevalence of vascular risk factors, causes of stroke, stroke severity, early signs of cerebral ischemia, duration of endovascular intervention, type of occlusion, and prevalence of leptomeningeal collateral vessels), recanalization rates, and clinical outcomes for patients in the endovascular group were compared with those for patients in the medical group (10 women, 21 men; mean age, 62 years +/- 12) who experienced ischemic stroke in the territory of the MCA as a result of ICA occlusion and who received antithrombotic treatment only. Differences between groups were assessed by using the chi2 test. A logistic regression analysis was performed to assess the effect of clinical and radiologic factors on recanalization rates and outcome.
ICA recanalization was successful in 21 patients. Good recanalization of the MCA was achieved in 11 patients. In nine of these patients, recanalization of the MCA was achieved by using mechanical IAT only. In the remaining 12 patients, administration of intraarterial urokinase was performed in addition to mechanical thrombolysis. Two patients from the endovascular group experienced symptomatic intracerebral hemorrhage. At 3 months, 56% of the endovascular group and 26% of the medical group had a favorable outcome. Mortality was 20% in the endovascular and 16% in the medical group.
IAT and stent implantation in the proximal segment of the ICA seem to improve the outcome for patients with ischemic stroke caused by occlusion of the cervical portion of the ICA.
回顾性评估大脑中动脉（MCA）供血区急性缺血性卒中患者，在接受动脉内溶栓（IAT）的同时，于颈内动脉（ICA）近端行支架植入术的治疗效果。
机构伦理委员会批准了支架植入及临床和影像学数据的回顾性分析。在获得患者或其近亲的知情同意后进行血管内治疗。回顾性审查无需知情同意。在进行药物和/或机械性IAT后，连续25例患者（7例女性，18例男性；平均年龄59岁±14[标准差]）在ICA近端行支架植入术（血管内治疗组）。将血管内治疗组患者的临床和影像学特征（即症状发作至到达急诊科的时间间隔、血管危险因素的患病率、卒中病因、卒中严重程度、脑缺血的早期体征、血管内介入持续时间、闭塞类型和软脑膜侧支血管的患病率）、再通率和临床结局，与仅接受抗栓治疗、因ICA闭塞导致MCA供血区缺血性卒中的药物治疗组患者（10例女性，21例男性；平均年龄62岁±12）进行比较。采用χ²检验评估组间差异。进行逻辑回归分析以评估临床和影像学因素对再通率和结局的影响。
21例患者ICA再通成功。11例患者MCA实现了良好再通。其中9例患者仅通过机械性IAT实现了MCA再通。其余12例患者除机械溶栓外还进行了动脉内尿激酶给药。血管内治疗组有2例患者发生症状性脑出血。3个月时，血管内治疗组56%的患者和药物治疗组26%的患者预后良好。血管内治疗组死亡率为20%，药物治疗组为16%。
IAT及ICA近端支架植入术似乎可改善因颈段ICA闭塞所致缺血性卒中患者的预后。
