Kim G E, Yoon W, Kim S K, Kim B C, Heo T W, Baek B H, Lee Y Y, Yim N Y
From the Departments of Radiology (G.E.K., W.Y., S.K.K., T.W.H., B.H.B., Y.Y.L., N.Y.Y.).
From the Departments of Radiology (G.E.K., W.Y., S.K.K., T.W.H., B.H.B., Y.Y.L., N.Y.Y.)
AJNR Am J Neuroradiol. 2016 Sep;37(9):1690-5. doi: 10.3174/ajnr.A4770. Epub 2016 Apr 14.
A major concern after emergent intracranial angioplasty in cases of acute stroke with underlying intracranial stenosis is the acute reocclusion of the treated arteries. This study reports the incidence and clinical outcomes of acute reocclusion of arteries following emergent intracranial angioplasty with or without stent placement for the management of patients with acute stroke with underlying intracranial atherosclerotic stenosis.
Forty-six patients with acute stroke received emergent intracranial angioplasty with or without stent placement for intracranial atherosclerotic stenosis and underwent follow-up head CTA. Acute reocclusion was defined as "hypoattenuation" within an arterial segment with discrete discontinuation of the arterial contrast column, both proximal and distal to the hypoattenuated lesion, on CTA performed before discharge. Angioplasty was defined as "suboptimal" if a residual stenosis of ≥50% was detected on the postprocedural angiography. Clinical and radiologic data of patients with and without reocclusion were compared.
Of the 46 patients, 29 and 17 underwent angioplasty with and without stent placement, respectively. Acute reocclusion was observed in 6 patients (13%) and was more frequent among those with suboptimal angioplasty than among those without it (71.4% versus 2.6%, P < .001). The relative risk of acute reocclusion in patients with suboptimal angioplasty was 27.857 (95% confidence interval, 3.806-203.911). Furthermore, a good outcome was significantly less frequent in patients with acute reocclusion than in those without it (16.7% versus 67.5%, P = .028).
Acute reocclusion of treated arteries was common after emergent intracranial angioplasty with or without stent placement in patients with acute stroke with intracranial atherosclerotic stenosis and was associated with a poor outcome. Suboptimal results of angioplasty appear to be associated with acute reocclusion, irrespective of whether stent placement was performed.
对于伴有颅内狭窄的急性卒中患者，急诊颅内血管成形术后主要关注的问题是治疗动脉的急性再闭塞。本研究报告了在伴有颅内动脉粥样硬化狭窄的急性卒中患者中，行急诊颅内血管成形术（无论是否置入支架）后动脉急性再闭塞的发生率及临床结局。
46例急性卒中患者因颅内动脉粥样硬化狭窄接受了急诊颅内血管成形术（无论是否置入支架），并接受了随访头部CTA检查。急性再闭塞定义为出院前行CTA检查时，动脉节段内出现“低密度影”，且该病变近端和远端的动脉造影剂柱离散中断。如果术后血管造影显示残余狭窄≥50%，则血管成形术被定义为“效果欠佳”。比较了有或无再闭塞患者的临床和影像学数据。
46例患者中，分别有29例和17例接受了置入支架和未置入支架的血管成形术。6例患者（13%）出现急性再闭塞，在血管成形术效果欠佳的患者中比未出现效果欠佳的患者更常见（71.4%对2.6%，P <.001）。血管成形术效果欠佳的患者发生急性再闭塞的相对风险为27.857（95%置信区间，3.806 - 203.911）。此外，急性再闭塞患者的良好结局明显少于未发生急性再闭塞的患者（16.7%对67.5%，P =.028）。
对于伴有颅内动脉粥样硬化狭窄的急性卒中患者，无论是否置入支架，急诊颅内血管成形术后治疗动脉的急性再闭塞都很常见，且与不良结局相关。血管成形术效果欠佳似乎与急性再闭塞有关，无论是否进行了支架置入。
