Leker Ronen R, Eichel Roni, Keigler Galina, Gomori John M, Cohen Jose E
Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Int J Stroke. 2015 Jun;10(4):560-4. doi: 10.1111/ijs.12192. Epub 2013 Nov 10.
It remains unclear whether occlusion site impacts outcome in patients with acute carotid artery occlusions.
Patients with acute carotid artery occlusion that underwent endovascular reperfusion treatments were prospectively enrolled. Patients with extracranial carotid bifurcation occlusions were compared with those with intracranial carotid-T-occlusions. Collected data included demographics, risk factor profile, and procedure-related variables. Neurological deficits were studied with the National Institutes of Health Stroke Scale and outcome was studied with the modified Rankin Score at day 90 after stroke and dichotomized into favorable (≤2) or unfavorable (>3). Recanalization status was studied with the thrombolysis in cerebral infarction scale.
We included 51 patients (33 with extracranial bifurcation occlusion and 18 with intracranial T-occlusion). Patients with T lesions were significantly older (median 74 versus 56 years, P = 0.02), more frequently had atrial fibrillation (61% versus 18%; P = 0.005) and cardioembolism (78% versus 21% P = 0.001), smoked less often (6% versus 42%; P = 0.01), and less often required stent implantation (11% versus 48%; P = 0.015). However, neurological severity, other procedure and peri-procedure-related variables including recanalization rates and percentages of symptomatic hemorrhages did not differ between the groups. Mortality rates (24% versus 23%) and chances for favorable outcomes (33% versus 24%) did not significantly differ. On multivariate logistic regression analysis, occlusion location was not a significant modifier of outcome.
Despite differences in stroke risk factors and treatments used between patients with extracranial bifurcation and intracranial T-occlusions, lesion location in itself does not influence outcome in patients with acute carotid artery occlusion treated with endovascular reperfusion.
急性颈动脉闭塞患者的闭塞部位是否会影响预后仍不清楚。
前瞻性纳入接受血管内再灌注治疗的急性颈动脉闭塞患者。将颅外颈动脉分叉闭塞患者与颅内颈动脉T形闭塞患者进行比较。收集的数据包括人口统计学、危险因素概况和与手术相关的变量。采用美国国立卫生研究院卒中量表研究神经功能缺损情况，并在卒中后90天采用改良Rankin量表研究预后情况，将其分为良好（≤2分）或不良（>3分）。采用脑梗死溶栓量表研究再通状态。
我们纳入了51例患者（33例颅外分叉闭塞患者和18例颅内T形闭塞患者）。T形病变患者年龄显著更大（中位数74岁对56岁，P = 0.02），房颤（61%对18%；P = 0.005）和心源性栓塞（78%对21%，P = 0.001）更为常见，吸烟较少（6%对42%；P = 0.01），需要支架植入的情况也较少（11%对48%；P = 0.015）。然而，两组之间的神经功能严重程度、其他手术及围手术期相关变量（包括再通率和症状性出血百分比）并无差异。死亡率（24%对23%）和良好预后的几率（33%对24%）也无显著差异。多因素逻辑回归分析显示，闭塞部位并非预后的显著影响因素。
尽管颅外分叉闭塞和颅内T形闭塞患者在卒中危险因素和治疗方法上存在差异，但病变部位本身并不影响接受血管内再灌注治疗的急性颈动脉闭塞患者的预后。
