急性串联闭塞的血管内卒中治疗：单中心经验
Endovascular Stroke Treatment of Acute Tandem Occlusion: A Single-Center Experience.
作者信息
Sallustio Fabrizio, Motta Caterina, Koch Giacomo, Pizzuto Silvia, Campbell Bruce C V, Diomedi Marina, Rizzato Barbara, Davoli Alessandro, Loreni Giorgio, Konda Daniel, Stefanini Matteo, Fabiano Sebastiano, Pampana Enrico, Stanzione Paolo, Gandini Roberto
机构信息
Comprehensive Stroke Center and Department of Neuroscience, University of Tor Vergata, Rome, Italy; Neurorehabilitation Unit, Santa Lucia Foundation, Rome, Italy.
Comprehensive Stroke Center and Department of Neuroscience, University of Tor Vergata, Rome, Italy; Neurorehabilitation Unit, Santa Lucia Foundation, Rome, Italy.
出版信息
J Vasc Interv Radiol. 2017 Apr;28(4):543-549. doi: 10.1016/j.jvir.2017.01.007. Epub 2017 Mar 1.
PURPOSE
To evaluate outcomes and prognostic factors in patients with acute ischemic stroke caused by tandem internal carotid artery/middle cerebral artery occlusion undergoing endovascular treatment.
MATERIALS AND METHODS
Characteristics of consecutive patients with tandem occlusion (TO) were extracted from a prospective registry. Collateral vessel quality on pretreatment computed tomographic (CT) angiography was evaluated on a 4-point grading scale, and patients were dichotomized as having poor or good collateral flow. Outcome measures included successful reperfusion according to Thrombolysis In Cerebral Infarction score, good outcome at 3 months defined as a modified Rankin scale score ≤ 2, symptomatic intracranial hemorrhage (ICH; sICH), and mortality.
RESULTS
A total of 72 patients with TO (mean age, 65.6 y ± 12.8) were treated. Intravenous thrombolysis was performed in 54.1% of patients, and a carotid stent was inserted in 48.6%. Successful reperfusion was achieved in 64% of patients, and a good outcome was achieved in 32%. sICH occurred in 12.5% of patients, and the overall mortality rate was 32%. Univariate analysis demonstrated that good outcome was associated with good collateral flow (P = .0001), successful reperfusion (P = .001), and lower rate of any ICH (P = .02) and sICH (P = .04). On multivariate analysis, good collateral flow (odds ratio [OR], 0.18; 95% confidence interval [CI], 0.04-0.75; P = .01) and age (OR, 1.08; 95% CI, 1.01-1.15; P = .01) were the only predictors of good outcome. The use of more than one device for thrombectomy was the only predictor of sICH (OR, 10.74; 95% CI, 1.37-84.13; P = .02).
CONCLUSIONS
Endovascular treatment for TO resulted in good outcomes. Collateral flow and age were independent predictors of good clinical outcomes at 3 months.
目的
评估接受血管内治疗的串联性颈内动脉/大脑中动脉闭塞所致急性缺血性卒中患者的治疗结果及预后因素。
材料与方法
从一项前瞻性登记研究中提取串联闭塞（TO）连续患者的特征。根据治疗前计算机断层扫描（CT）血管造影对侧支血管质量进行4分制评分，并将患者分为侧支血流差或好两组。结果指标包括根据脑梗死溶栓评分的成功再灌注、3个月时良好结局（改良Rankin量表评分≤2）、症状性颅内出血（sICH）和死亡率。
结果
共治疗72例TO患者（平均年龄65.6岁±12.8岁）。54.1%的患者接受了静脉溶栓治疗，48.6%的患者植入了颈动脉支架。64%的患者实现了成功再灌注，32%的患者获得了良好结局。12.5%的患者发生了sICH，总体死亡率为32%。单因素分析表明，良好结局与良好的侧支血流（P = .0001）、成功再灌注（P = .001）以及任何颅内出血（P = .02）和sICH发生率较低（P = .04）相关。多因素分析显示，良好的侧支血流（比值比[OR]，0.18；95%置信区间[CI]，0.04 - 0.75；P = .01）和年龄（OR，1.08；95% CI，1.01 - 1.15；P = .01）是良好结局的唯一预测因素。使用一种以上器械进行血栓切除术是sICH的唯一预测因素（OR，10.74；95% CI，1.37 - 84.13；P = .02）。
结论
TO的血管内治疗取得了良好效果。侧支血流和年龄是3个月时良好临床结局的独立预测因素。
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