Yang Dong, Lin Min, Wang Shuiping, Wang Huaiming, Hao Yonggang, Zi Wenjie, Lv Penghua, Zheng Dequan, Xiao Guodong, Xu Gelin, Xiong Yunyun, Liu Xinfeng
1 Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu Province, China.
2 Department of Neurology, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, Fujian Province, China.
Interv Neuroradiol. 2018 Aug;24(4):412-420. doi: 10.1177/1591019918763380. Epub 2018 Mar 21.
Objective The objective of this article is to compare the effectiveness of primary angioplasty and/or stenting with stent retriever thrombectomy in acute anterior large-vessel occlusion due to atherosclerotic disease. Methods Patients were retrospectively reviewed from the endovascular treatment for acute anterior circulation ischemic stroke registry. Patients with large-vessel occlusions due to atherosclerosis were selected. We evaluated modified Rankin Scale (mRS) score at 90 days, modified thrombolysis in cerebral infarction (mTICI) score immediately post-procedure, and symptomatic and asymptomatic intracranial hemorrhage within 72 hours. Results Of 302 patients with acute anterior circulation occlusion due to atherosclerotic disease, 269 were treated with stent retriever thrombectomy as first-line therapy and 33 with angioplasty and/or stenting. Patients who received primary angioplasty treatment showed favorable independent outcome at 90 days (69.7% (23/33) vs 47.6% (128/269), p = 0.02) and lower rate of asymptomatic intracranial hemorrhage (9.1% (3/23) vs 30.5% (82/269), p = 0.01). Recanalization immediately post procedure did not differ (78.8%% (26/33) vs 86.2% (232/269), p = 0.29). Primary angioplasty therapy (OR, 0.27; 95% confidence interval (CI): 0.08-0.90; p = 0.03) and small baseline infarct (OR 0.36: 0.16-0.82; p = 0.02) were protective factors against poor functional outcome, while old age (OR 1.04:1.01-1.07; p = 0.006), severe neurological deficits (OR 3.76: 2.00-7.07; p < 0.001), and high glucose (OR 1.11: 1.01-1.23; p = 0.03) were associated with poor prognosis. Conclusions Patients with acute anterior circulation large-vessel occlusion due to atherosclerosis may benefit from urgent angioplasty and/or stenting as first-line therapy. Randomized controlled trials are warranted.
目的 本文旨在比较原发性血管成形术和/或支架置入术与支架取栓术治疗动脉粥样硬化性疾病所致急性前循环大血管闭塞的有效性。方法 对急性前循环缺血性卒中登记研究的血管内治疗患者进行回顾性分析。选取动脉粥样硬化所致大血管闭塞患者。评估90天时的改良Rankin量表（mRS）评分、术后即刻的改良脑梗死溶栓（mTICI）评分以及72小时内的有症状和无症状颅内出血情况。结果 在302例因动脉粥样硬化性疾病导致急性前循环闭塞的患者中，269例接受支架取栓术作为一线治疗，33例接受血管成形术和/或支架置入术。接受原发性血管成形术治疗的患者在90天时显示出良好的独立预后（69.7%（23/33）对47.6%（128/269），p = 0.02），且无症状颅内出血发生率较低（9.1%（3/23）对30.5%（82/269），p = 0.01）。术后即刻再通情况无差异（78.8%（26/33）对86.2%（232/269），p = 0.29）。原发性血管成形术治疗（比值比，0.27；95%置信区间（CI）：0.08 - 0.90；p = 0.03）和基线梗死灶较小（比值比0.36：0.16 - 0.82；p = 0.02）是功能预后不良的保护因素，而老年（比值比1.04：1.01 - 1.07；p = 0.006）、严重神经功能缺损（比值比3.76：2.00 - 7.07；p < 0.001）和高血糖（比值比1.11：1.01 - 1.23；p = 0.03）与预后不良相关。结论 因动脉粥样硬化导致急性前循环大血管闭塞的患者可能从紧急血管成形术和/或支架置入术作为一线治疗中获益。有必要进行随机对照试验。
