Akpinar Cetin K, Gürkaş Erdem, Aytac Emrah
1 Ankara Numune Training and Research Hospital, Neurology Clinic, Ankara, Turkey.
2 Fırat University, Medical Faculty, Neurology, Elazig, Turkey.
Interv Neuroradiol. 2017 Aug;23(4):405-411. doi: 10.1177/1591019917701113. Epub 2017 May 15.
Background The aim of the study was to assess the efficacy of balloon angioplasty-assisted mechanical thrombectomy without urgent stenting in the carotid artery as another approach for endovascular treatment of tandem occlusions. Methods Fifteen consecutive cases of tandem occlusions treated with the endovascular approach between January 2014 and May 2016 were reviewed. The study cohort included patients with an etiology of large vessel atherosclerosis. Extracranial carotid stenting was performed in another session if post-thrombectomy mRS modified Rankin Score (mRS) was 0-2. Good clinical outcome was determined by follow-up at 7-10, 30 and 90 days according to the mRS. Results Most patients (80%) were male. Eight (53.4%) patients received intravenous thrombolysis before angiography. Proximal revascularization was successful in 100% of cases with balloon angioplasty internal carotid artery (ICA) origin. Successful recanalization (modified thrombolysis in cerebral infarction (mTICI) 2b-3) (mTICI 2 b-3) occurred in 12 cases (80%) and good clinical outcomes were achieved in 10 patients (66.7%). Cervical ICA stent placement was performed in 10 patients with good clinical outcomes. No symptomatic intracranial hemorrhage occurred after delayed ICA stenting Conclusions This is the first reported case series to evaluate this approach for endovascular treatment of tandem occlusions. Carotid angioplasty-assisted mechanical thrombectomy without urgent stenting seems to be a safer approach.
背景 本研究的目的是评估在颈动脉中不进行紧急支架置入的球囊血管成形术辅助机械血栓切除术作为串联闭塞血管内治疗的另一种方法的疗效。方法 回顾了2014年1月至2016年5月间连续15例采用血管内方法治疗的串联闭塞病例。研究队列包括病因是大血管动脉粥样硬化的患者。如果血栓切除术后改良Rankin量表（mRS）评分为0 - 2，则在另一次手术中进行颅外颈动脉支架置入。根据mRS在7 - 10天、30天和90天进行随访来确定良好的临床结局。结果 大多数患者（80%）为男性。8例（53.4%）患者在血管造影前接受了静脉溶栓治疗。球囊血管成形术治疗颈内动脉（ICA）起始处的近端血管再通在所有病例中成功率为100%。12例（80%）实现了成功再通（改良脑梗死溶栓（mTICI）2b - 3级），10例患者（66.7%）获得了良好的临床结局。10例临床结局良好的患者进行了颈ICA支架置入。延迟ICA支架置入后未发生有症状的颅内出血。结论 这是首个报道的评估这种串联闭塞血管内治疗方法的病例系列。不进行紧急支架置入的颈动脉血管成形术辅助机械血栓切除术似乎是一种更安全的方法。
