Rentzos Alexandros, Karlsson Jan-Erik, Lundqvist Christer, Rosengren Lars, Hellström Mikael, Wikholm Gunnar
1 Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
2 Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
Interv Neuroradiol. 2018 Aug;24(4):405-411. doi: 10.1177/1591019918762320. Epub 2018 Mar 21.
Background and purpose Recent randomized clinical trials have proved the efficacy of endovascular treatment of acute ischemic stroke in the anterior circulation. However, the benefit of endovascular treatment of ischemic stroke in the posterior circulation remains to be proven since it was excluded from these trials. We evaluate the benefit of endovascular treatment in posterior circulation strokes. Methods A total of 110 consecutive patients with posterior circulation stroke who underwent endovascular treatment in our institute in the period 1991-2015 were included. Recanalization rate according to modified Treatment in Cerebral Ischemia score and neurological outcome at three months according to modified Rankin Scale were the main outcomes. Collateral circulation, procedural complications and radiological outcome were evaluated in the radiological examinations. Results The median National Institutes of Health Stroke Scale was 31 (IQR: 13-31) and median time from symptom onset to groin puncture was 300 (IQR: 175-463) minutes. Successful recanalization was seen in 80 of 110 patients (73%). Favorable outcome (modified Rankin Scale ≤2) was seen in 38 patients (35%) while moderate favorable outcome (≤3) was seen in 48 patients (44%). Symptomatic intracerebral hemorrhage occurred in 10 patients (9%). An association between collateral circulation, recanalization rate and outcome was seen. Conclusion Endovascular treatment for posterior circulation stroke in this single-center cohort is relatively safe and effective with decreased mortality and increased favorable outcome compared to natural history.
背景与目的 近期的随机临床试验已证实血管内治疗在前循环急性缺血性卒中中的疗效。然而，由于后循环缺血性卒中被排除在这些试验之外，其血管内治疗的益处仍有待证实。我们评估了血管内治疗在后循环卒中中的益处。方法 纳入了1991年至2015年期间在我院接受血管内治疗的110例连续的后循环卒中患者。主要结局指标为根据改良脑缺血治疗评分的再通率以及根据改良Rankin量表评估的三个月时的神经功能结局。在影像学检查中评估侧支循环、手术并发症和影像学结局。结果 美国国立卫生研究院卒中量表中位数为31（四分位间距：13 - 31），症状发作至股动脉穿刺的中位时间为300（四分位间距：175 - 463）分钟。110例患者中有80例（73%）实现了成功再通。38例患者（35%）获得了良好结局（改良Rankin量表≤2），48例患者（44%）获得了中度良好结局（≤3）。10例患者（9%）发生了症状性脑出血。观察到侧支循环、再通率与结局之间存在关联。结论 在这个单中心队列中，后循环卒中的血管内治疗相对安全有效，与自然病程相比，死亡率降低，良好结局增加。
