Lee Y Y, Yoon W, Kim S K, Baek B H, Kim G S, Kim J T, Park M S
From the Departments of Radiology (Y.Y.L., W.Y., S.K.K., B.H.B., G.S.K.).
From the Departments of Radiology (Y.Y.L., W.Y., S.K.K., B.H.B., G.S.K.)
AJNR Am J Neuroradiol. 2017 Aug;38(8):1600-1604. doi: 10.3174/ajnr.A5233. Epub 2017 May 25.
Prediction of underlying intracranial atherosclerotic stenosis before endovascular therapy might be helpful for appropriate therapeutic planning in patients with acute ischemic stroke. This study aimed to compare the characteristics and treatment outcomes in patients with acute basilar artery occlusion relative to the existence or nonexistence of underlying intracranial atherosclerotic stenosis.
Sixty-two patients with acute basilar artery occlusion underwent multimodal endovascular therapy. All patients underwent stent-retriever thrombectomy as a first-line endovascular therapy. Patients with underlying intracranial atherosclerotic stenosis underwent additional intracranial angioplasty and stent placement. The clinical and imaging characteristics and treatment outcomes were retrospectively analyzed and compared between patients with and without intracranial atherosclerotic stenosis.
Underlying intracranial atherosclerotic stenosis was identified at the occlusion site in 15 patients (24.1%). Occlusion in the proximal segment of the basilar artery was more common in patients with intracranial atherosclerotic stenosis (60% versus 6.4%, < .001), whereas occlusion in the distal segment was more common in those without it (91.5% versus 26.7%, < .001). Bilateral thalamic infarction on a pretreatment DWI was less common in patients with intracranial atherosclerotic stenosis (0% versus 27.7%, = .027) compared with those without it. There were no significant differences in the rates of successful revascularization, favorable outcome, symptomatic hemorrhage, and mortality between the 2 groups.
Underlying intracranial atherosclerotic stenosis was not uncommon in patients with acute basilar artery occlusion. The occlusion segment of the basilar artery and the presence or absence of bilateral thalamic infarction on a pretreatment DWI might be helpful for predicting underlying intracranial atherosclerotic stenosis in patients with acute basilar artery occlusion. Patients with and without underlying intracranial atherosclerotic stenosis who underwent endovascular therapy had similar outcomes.
在血管内治疗前预测潜在的颅内动脉粥样硬化狭窄，可能有助于对急性缺血性卒中患者进行适当的治疗规划。本研究旨在比较急性基底动脉闭塞患者中，存在或不存在潜在颅内动脉粥样硬化狭窄时的特征及治疗结果。
62例急性基底动脉闭塞患者接受了多模式血管内治疗。所有患者均接受支架取栓术作为一线血管内治疗。存在潜在颅内动脉粥样硬化狭窄的患者接受了额外的颅内血管成形术和支架置入术。对有和没有颅内动脉粥样硬化狭窄的患者的临床和影像特征及治疗结果进行回顾性分析和比较。
15例患者（24.1%）在闭塞部位发现潜在的颅内动脉粥样硬化狭窄。颅内动脉粥样硬化狭窄患者中，基底动脉近端闭塞更为常见（60% 对6.4%，P <.001），而在无狭窄患者中，远端闭塞更为常见（91.5% 对26.7%，P <.001）。与无狭窄患者相比，颅内动脉粥样硬化狭窄患者在治疗前DWI上双侧丘脑梗死较少见（0% 对27.7%，P = .027）。两组在血管再通成功率、良好结局、症状性出血和死亡率方面无显著差异。
急性基底动脉闭塞患者中，潜在的颅内动脉粥样硬化狭窄并不少见。基底动脉闭塞节段以及治疗前DWI上双侧丘脑梗死的有无，可能有助于预测急性基底动脉闭塞患者潜在的颅内动脉粥样硬化狭窄。接受血管内治疗的有和没有潜在颅内动脉粥样硬化狭窄的患者，结局相似。
