Yoon Woong, Kim Byung Moon, Kim Dong Joon, Kim Dong Ik, Kim Seul Kee
*Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea; ‡Department of Radiology, Severance Stroke Center, Yonsei University College of Medicine Severance Hospital, Seoul, South Korea.
Neurosurgery. 2015 Mar;76(3):321-9. doi: 10.1227/NEU.0000000000000610.
The optimal treatment for hyperacute stroke attributable to cervical internal carotid artery (C-ICA) occlusion remains controversial.
This study sought to evaluate clinical outcomes and prognostic factors after carotid artery stenting (CAS) in patients with hyperacute stroke within 6 hours of onset.
Forty-seven patients with hyperacute stroke attributable to atherosclerotic C-ICA occlusion underwent emergent CAS. Forty-two patients (89.4%) had tandem intracranial artery occlusion (TIO). When patients showed remnant M1 or proximal M2 occlusions after CAS, intracranial recanalization therapy was performed by using pharmacologic thrombolysis and mechanical thrombectomy with a Solitaire stent. Clinical and radiologic data were compared between patients with favorable (modified Rankin scale, 0-2) and unfavorable outcomes. Binary logistic regression analysis was used to find independent prognostic factors.
Emergent CAS was successful in all but 1 patient. Seven (16.7%) of 42 patients with TIO did not need further treatment, because thrombolysis in cerebral ischemia ≥2b was achieved immediately after CAS. Of the 35 patients who underwent intracranial recanalization therapy for remnant TIO, thrombolysis in cerebral ischemia ≥2b was achieved in 71.4% (25 of 35). Twenty-six patients (55.3%) had favorable outcomes, and mortality was 6.4% at 3 months. Time from symptom onset to carotid recanalization was inversely and independently associated with a favorable outcome for all patients and for those with TIO (P < .05).
In our patient group, emergent CAS for hyperacute stroke caused by atherosclerotic C-ICA occlusion seemed to be effective and safe. Time to carotid recanalization was inversely and independently associated with a favorable outcome.
颈内动脉（C-ICA）闭塞所致超急性卒中的最佳治疗方法仍存在争议。
本研究旨在评估发病6小时内超急性卒中患者行颈动脉支架置入术（CAS）后的临床结局及预后因素。
47例因动脉粥样硬化性C-ICA闭塞导致超急性卒中的患者接受了急诊CAS。42例患者（89.4%）存在串联颅内动脉闭塞（TIO）。当患者在CAS后显示M1残端或M2近端闭塞时，采用药物溶栓及使用Solitaire支架进行机械取栓术进行颅内再通治疗。比较预后良好（改良Rankin量表评分，0 - 2分）和预后不良患者的临床及影像学数据。采用二元逻辑回归分析寻找独立的预后因素。
除1例患者外，急诊CAS均成功。42例TIO患者中有7例（16.7%）无需进一步治疗，因为CAS后立即实现了脑缺血溶栓≥2b级。在35例因TIO残端接受颅内再通治疗的患者中，71.4%（35例中的25例）实现了脑缺血溶栓≥2b级。26例患者（55.3%）预后良好，3个月时死亡率为6.4%。症状发作至颈动脉再通的时间与所有患者及TIO患者的良好预后呈负相关且具有独立相关性（P < .05）。
在我们的患者组中，动脉粥样硬化性C-ICA闭塞所致超急性卒中的急诊CAS似乎有效且安全。颈动脉再通时间与良好预后呈负相关且具有独立相关性。
