Qureshi Adnan I, Hussein Haitham M, Abdelmoula Mohamed, Georgiadis Alexandros L, Janjua Nazli
Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, Minneapolis, MN 55455, USA.
Neurocrit Care. 2009;10(2):195-203. doi: 10.1007/s12028-008-9161-0. Epub 2008 Dec 3.
To determine the rate of subacute recanalization and reocclusion and its effect on clinical outcomes among patients with ischemic stroke treated with endovascular treatment. Subacute recanalization and reocclusion occurring hours after completion of the intravenous or intra-arterial thrombolysis for acute ischemic stroke has been reported in anecdotal cases.
We performed cerebral angiography at 24 h to determine the status of occlusion after endovascular treatment (compared with immediate post-procedure angiogram) in a series of patients with ischemic stroke treated with endovascular treatment. Clinical and radiological evaluations were performed before and 24 h, and prior to discharge or 1-3 months after treatment. We performed multivariate analysis to evaluate the effect of subacute recanalization on clinical outcome graded using modified Rankin scale (mRS). Favorable outcome was defined by mRS of 0-2.
A total of 56 patients (mean age 66 +/- 14 years; 22 were men) were analyzed. Subacute recanalization was observed in 16 (29%) patients and consisted of additional recanalization in 8 patients with early recanalization. Subacute recanalization was associated with a trend toward a higher rate of favorable outcome (Wald chi-square 3.3, P = 0.19) after adjusting for other covariates. Subacute recanalization was not associated with either neurological deterioration or symptomatic intracranial hemorrhage. Subacute reocclusion was observed in 5 (9%) patients. Subacute reocclusion was associated with a trend toward higher rate of neurological deterioration within 24 h (Wald chi-square 2.1, P = 0.15) after adjusting for other covariates.
We found that new or additional recanalization occurs in one-fourth of the patients within 24 h of endovascular treatment and is not associated with any adverse consequences. Subacute reocclusion occurs infrequently after endovascular treatment.
确定接受血管内治疗的缺血性卒中患者亚急性再通和再闭塞的发生率及其对临床结局的影响。急性缺血性卒中静脉或动脉内溶栓完成数小时后发生亚急性再通和再闭塞的情况已有个别病例报道。
我们对一系列接受血管内治疗的缺血性卒中患者在24小时时进行脑血管造影，以确定血管内治疗后（与术后即刻血管造影相比）的闭塞状态。在治疗前、24小时时、出院前或治疗后1 - 3个月进行临床和影像学评估。我们进行多变量分析以评估亚急性再通对使用改良Rankin量表（mRS）分级的临床结局的影响。良好结局定义为mRS为0 - 2。
共分析了56例患者（平均年龄66±14岁；22例为男性）。16例（29%）患者观察到亚急性再通，其中8例早期再通患者出现额外再通。在调整其他协变量后，亚急性再通与良好结局率较高的趋势相关（Wald卡方值3.3，P = 0.19）。亚急性再通与神经功能恶化或症状性颅内出血均无关。5例（9%）患者观察到亚急性再闭塞。在调整其他协变量后，亚急性再闭塞与24小时内神经功能恶化率较高的趋势相关（Wald卡方值2.1，P = 0.15）。
我们发现，在血管内治疗后24小时内，四分之一的患者出现新的或额外的再通，且与任何不良后果无关。血管内治疗后亚急性再闭塞很少发生。
