Steglich-Arnholm Henrik, Holtmannspötter Markus, Kondziella Daniel, Wagner Aase, Stavngaard Trine, Cronqvist Mats E, Hansen Klaus, Højgaard Joan, Taudorf Sarah, Krieger Derk Wolfgang
Department of Neurology 2082, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
Department of Neuroradiology, Rigshospitalet, Copenhagen, Denmark.
J Neurol. 2015 Dec;262(12):2668-75. doi: 10.1007/s00415-015-7895-0. Epub 2015 Sep 7.
Extracranial carotid artery occlusion or high-grade stenosis with concomitant intracranial embolism causes severe ischemic stroke and shows poor response rates to intravenous thrombolysis (IVT). Endovascular therapy (EVT) utilizing thrombectomy assisted by carotid stenting was long considered risky because of procedural complexities and necessity of potent platelet inhibition-in particular following IVT. This study assesses the benefits and harms of thrombectomy assisted by carotid stenting and identifies factors associated with clinical outcome and procedural complications. Retrospective single-center analysis of 47 consecutive stroke patients with carotid occlusion or high-grade stenosis and concomitant intracranial embolus treated between September 2011 and December 2014. Benefits included early improvement of stroke severity (NIHSS ≥ 10) or complete remission within 72 h and favorable long-term outcome (mRS ≤ 2). Harms included complications during and following EVT. Mean age was 64.3 years (standard deviation ±12.5), 40 (85%) patients received IVT initially. Median NIHSS was 16 (inter-quartile range 14-19). Mean time from stroke onset to recanalization was 311 min (standard deviation ±78.0). Early clinical improvement was detected in 22 (46%) patients. Favorable outcome at 3 months occurred in 32 (68%) patients. Expedited patient management was associated with favorable clinical outcome. Two (4%) patients experienced symptomatic hemorrhage. Eight (17%) patients experienced stent thrombosis. Four (9%) patients died. Thrombectomy assisted by carotid stenting seems beneficial and reasonably safe with a promising rate of favorable outcome. Nevertheless, adverse events and complications call for additional clinical investigations prior to recommendation as clinical standard. Expeditious patient management is central to achieve good clinical outcome.
颅外颈动脉闭塞或伴有颅内栓塞的高度狭窄会导致严重的缺血性中风，并且对静脉溶栓治疗（IVT）的反应率较低。由于操作复杂以及需要强效血小板抑制（尤其是在IVT之后），长期以来，利用颈动脉支架辅助血栓切除术的血管内治疗（EVT）被认为具有风险。本研究评估了颈动脉支架辅助血栓切除术的益处和危害，并确定了与临床结局和手术并发症相关的因素。对2011年9月至2014年12月期间连续治疗的47例患有颈动脉闭塞或高度狭窄并伴有颅内栓子的中风患者进行回顾性单中心分析。益处包括中风严重程度早期改善（美国国立卫生研究院卒中量表[NIHSS]≥10）或在72小时内完全缓解以及良好的长期结局（改良Rankin量表[mRS]≤2）。危害包括EVT期间及之后的并发症。平均年龄为64.3岁（标准差±12.5），40例（85%）患者最初接受了IVT。NIHSS中位数为16（四分位间距14 - 19）。从中风发作到再通的平均时间为311分钟（标准差±78.0）。22例（46%）患者出现早期临床改善。32例（68%）患者在3个月时获得良好结局。快速的患者管理与良好的临床结局相关。2例（4%）患者发生症状性出血。8例（17%）患者发生支架血栓形成。4例（9%）患者死亡。颈动脉支架辅助血栓切除术似乎有益且相当安全，具有良好结局的可观比例。然而，不良事件和并发症需要在推荐作为临床标准之前进行更多的临床研究。快速的患者管理是实现良好临床结局的关键。
