急性缺血性卒中患者颅外颈内动脉急诊支架置入联合前循环取栓术：一项回顾性多中心研究
Emergency Stenting of the Extracranial Internal Carotid Artery in Combination with Anterior Circulation Thrombectomy in Acute Ischemic Stroke: A Retrospective Multicenter Study.
作者信息
Behme D, Mpotsaris A, Zeyen P, Psychogios M N, Kowoll A, Maurer C J, Joachimski F, Liman J, Wasser K, Kabbasch C, Berlis A, Knauth M, Liebig T, Weber W
机构信息
From the Departments of Neuroradiology (D.B., M.N.P., M.K.)
Department of Radiology and Neuroradiology (A.M., P.Z., C.K., T.L.), University Cologne, University Hospital Cologne, Cologne, Germany.
出版信息
AJNR Am J Neuroradiol. 2015 Dec;36(12):2340-5. doi: 10.3174/ajnr.A4459. Epub 2015 Aug 20.
BACKGROUND AND PURPOSE
Several small case series reported a favorable clinical outcome for emergency stent placement in the extracranial internal carotid artery combined with mechanical thrombectomy in acute stroke. The rate of postinterventional symptomatic intracranial hemorrhages was reported to be as high as 20%. Therefore, we investigated the safety and efficacy of this technique in a large multicentric cohort.
MATERIALS AND METHODS
The data bases of 4 German stroke centers were screened for all patients who received emergency stent placement of the extracranial internal carotid artery in combination with mechanical thrombectomy of the anterior circulation between 2007 and 2014. The primary outcome measure was the rate of symptomatic intracranial hemorrhage according to the European Cooperative Acute Stroke Study III criteria; secondary outcome measures included the angiographic revascularization results and clinical outcome.
RESULTS
One hundred seventy patients with a median age of 64 years (range, 25-88 years) were treated. They presented after a median of 98 minutes (range, 52-160 minutes) with a median NIHSS score of 15 (range, 12-19). Symptomatic intracranial hemorrhages occurred in 15/170 (9%) patients; there was no statistically significant difference among groups pertaining to age, sex, intravenous rtPA, procedural timings, and the rate of successful recanalization. In 130/170 (77%) patients, a TICI score of ≥ 2b could be achieved. The in-hospital mortality rate was 19%, and 36% of patients had a favorable outcome at follow-up.
CONCLUSIONS
Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is effective and safe. It is not associated with a significantly higher risk of symptomatic intracranial hemorrhage compared with published series for mechanical thrombectomy alone.
背景与目的
几个小病例系列报道了在急性卒中患者中，对颅外颈内动脉进行急诊支架置入联合机械取栓术可取得良好的临床疗效。据报道，介入治疗后有症状性颅内出血的发生率高达20%。因此，我们在一个大型多中心队列中研究了该技术的安全性和有效性。
材料与方法
对4个德国卒中中心的数据库进行筛查，纳入2007年至2014年间接受颅外颈内动脉急诊支架置入联合前循环机械取栓术的所有患者。主要结局指标是根据欧洲急性卒中协作研究III标准得出的有症状性颅内出血发生率；次要结局指标包括血管造影再通结果和临床结局。
结果
共治疗了170例患者，中位年龄为64岁（范围25 - 88岁）。他们在症状出现后中位98分钟（范围52 - 160分钟）就诊，美国国立卫生研究院卒中量表（NIHSS）中位评分为15分（范围12 - 19分）。15/170（9%）例患者发生了有症状性颅内出血；在年龄、性别、静脉注射重组组织型纤溶酶原激活剂（rtPA）、手术时间以及成功再通率方面，各亚组之间无统计学显著差异。130/170（77%）例患者的脑梗死溶栓分级（TICI）评分≥2b。住院死亡率为19%，36%的患者在随访时有良好结局。
结论
颅外颈内动脉急诊支架置入联合前循环取栓术是有效且安全的。与仅进行机械取栓术的已发表系列研究相比，其有症状性颅内出血风险并未显著升高。
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