Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Neurointerv Surg. 2010 Mar;2(1):71-3. doi: 10.1136/jnis.2009.001081. Epub 2009 Dec 4.
Treatment of large artery cerebral occlusions is rapidly evolving. We hypothesized that patients with intracranial embolic occlusions secondary to an extracranial carotid artery stenosis or occlusion have a higher probability of successful endovascular recanalization compared with those with cardioembolic occlusions.
We retrospectively reviewed the databases of three institutions (University of Pittsburgh Medical Center (UPMC), Michigan State University (MSU) and Cleveland Clinic Foundation (CCF)) for acute anterior circulation ischemic strokes treated with endovascular therapies from January 2006 to July 2008. After collection of demographic, radiographic and angiographic variables, two groups were identified: artery to artery embolic occlusions and cardioembolic/cryptogenic intracranial occlusions. We defined recanalization as TIMI 2 or 3 flow. A binary logistic regression model was constructed to determine which characteristics were unique to patients with carotid embolic occlusions.
A total of 207 patients were identified (UPMC=100, CCF=71, MSU=36) with a mean age of 69±11 years and mean NIHSS of 17±5. Of these, 157 (75%) were due to a cardiac or cryptogenic source and 50 (25%) were from a carotid embolic source. The use of multimodal therapy (OR 2.6 (1.2-5.6), p<0.009) and the presence of a carotid embolic intracranial occlusion (OR 3.6 (1.2-7.1), p<0.012) were associated with successful recanalization, while carotid terminus occlusions were associated with unsuccessful recanalization (OR 0.35 (0.18-0.68), p<0.002).
Patients with intracranial occlusions secondary to an extracranial carotid stenosis or total occlusion appear to have more successful recanalization rates when treated with endovascular therapy compared with those with cardioembolic occlusions.
大动脉脑梗死的治疗方法正在迅速发展。我们假设，与心源性栓塞性闭塞相比，由于颅外颈动脉狭窄或闭塞引起的颅内栓塞性闭塞患者，血管内再通的成功率更高。
我们回顾性地分析了三家医院（匹兹堡大学医学中心（UPMC）、密歇根州立大学（MSU）和克利夫兰诊所基金会（CCF））的数据库，这些患者都在 2006 年 1 月至 2008 年 7 月期间接受了血管内治疗。在收集人口统计学、影像学和血管造影学变量后，我们将患者分为两组：动脉到动脉栓塞性闭塞和心源性/隐源性颅内闭塞。我们将再通定义为 TIMI 2 或 3 级血流。构建了二项逻辑回归模型来确定哪些特征是颈动脉栓塞性闭塞患者特有的。
共确定了 207 名患者（UPMC=100 名，CCF=71 名，MSU=36 名），平均年龄为 69±11 岁，NIHSS 平均为 17±5。其中，157 名（75%）患者为心源性或隐源性病因，50 名（25%）患者为颈动脉栓塞性病因。多模态治疗的使用（OR 2.6（1.2-5.6），p<0.009）和颈动脉内颅内栓塞的存在（OR 3.6（1.2-7.1），p<0.012）与再通成功相关，而颈动脉终末闭塞与再通失败相关（OR 0.35（0.18-0.68），p<0.002）。
与心源性栓塞性闭塞相比，接受血管内治疗的颅外颈动脉狭窄或闭塞引起的颅内闭塞患者，血管内再通的成功率似乎更高。
