Kurre Wiebke, Bansemir Kai, Aguilar Pérez Marta, Martinez Moreno Rosa, Schmid Elisabeth, Bäzner Hansjörg, Henkes Hans
Neuroradiologische Klinik, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
Institut für Neuroradiologie, Universitätsklinik Frankfurt, Goethe-Universität, Frankfurt, Germany.
Neuroradiology. 2016 Dec;58(12):1167-1179. doi: 10.1007/s00234-016-1757-z. Epub 2016 Oct 29.
In acute internal carotid artery dissection (a-ICAD) with concomitant intracranial large vessel occlusion or haemodynamic impairment, the effectiveness of medical treatment is limited and endovascular therapy (EVT) can be considered. Feasibility, safety and outcome of EVT in a-ICAD are not well described yet.
From an institutional database, we retrospectively selected consecutive patients treated for a-ICAD between January 2007 and July 2015. We assessed recanalization results defining <50 % residual stenosis and mTICI ≥2b as successful. Procedural adverse events and symptomatic haemorrhages were reported as well as clinical outcome at 90 days defining a mRS ≤2 as favourable. Follow-up angiographies were reviewed and retreatments reported.
In the defined period, 73 patients (mean age 48 years (31-73), mean NIHSS 11 (0-27)) received EVT for a-ICAD. The majority (60 %) had tandem occlusions. Cervical artery reconstruction was successful in 100 % and intracranial thrombectomy in 85 %. Thrombus formation (18 %) and thromboembolism (20 %) were the most frequent adverse events but clinically relevant only in 8 %. Symptomatic haemorrhage occurred in 5 %. Clinical outcome was favourable in 64 %, with a lower chance after tandem occlusion (55 vs. 79 %, p = 0.047). Death rate was 10 %. None of the patients developed recurrent ischaemic symptoms, but control angiography revealed abnormal findings of the reconstructed ICA in 38 % leading to retreatment in 17 %.
EVT of a-ICAD is feasible with a predominantly favourable clinical outcome. Improvement of devices and techniques is warranted to reduce the risk of thrombus formation and thromboembolism during treatment and insufficient vessel wall healing thereafter.
在伴有颅内大血管闭塞或血流动力学损害的急性颈内动脉夹层（a-ICAD）中，药物治疗效果有限，可考虑血管内治疗（EVT）。a-ICAD中EVT的可行性、安全性和疗效尚未得到充分描述。
从机构数据库中，我们回顾性选择了2007年1月至2015年7月期间接受a-ICAD治疗的连续患者。我们将残余狭窄<50%且改良脑梗死溶栓分级（mTICI）≥2b定义为再通成功来评估再通结果。报告了手术不良事件和症状性出血以及90天时的临床结局，将改良Rankin量表（mRS）≤2定义为良好。复查随访血管造影并报告再次治疗情况。
在规定期间，73例患者（平均年龄48岁（31 - 73岁），平均美国国立卫生研究院卒中量表（NIHSS）评分为11分（0 - 27分））接受了a-ICAD的EVT治疗。大多数（60%）有串联闭塞。颈段动脉重建成功率为100%，颅内血栓切除术成功率为85%。血栓形成（18%）和血栓栓塞（20%）是最常见的不良事件，但仅8%具有临床相关性。症状性出血发生率为5%。临床结局良好率为64%，串联闭塞后良好率较低（55%对79%，p = 0.047）。死亡率为10%。没有患者出现复发性缺血症状，但对照血管造影显示38%的重建颈内动脉有异常发现，其中17%需要再次治疗。
a-ICAD的EVT是可行的，临床结局大多良好。有必要改进设备和技术，以降低治疗期间血栓形成和血栓栓塞的风险以及随后血管壁愈合不良的风险。
