Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Bremen, Germany.
Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, Georgia.
JACC Cardiovasc Interv. 2018 Jul 9;11(13):1290-1299. doi: 10.1016/j.jcin.2018.05.036.
The aim of this study was to identify the optimal endovascular approach in patients with acute stroke with tandem lesions.
At present, there is no consensus about the ideal technical strategy for the endovascular treatment of patients with acute ischemic stroke with tandem lesions of the extracranial internal carotid artery (ICA) and intracranial cerebral arteries.
This was an international, multicenter registry with a total of 482 patients with acute ischemic stroke and tandem lesions. Patients were treated by intracranial thrombectomy as well as 1 of the following 4 strategies: 1) acute carotid artery stenting of the extracranial ICA with antithrombotic agents; 2) acute carotid artery stenting of the extracranial ICA without antithrombotic agents; 3) balloon angioplasty of the extracranial ICA; and 4) intracranial thrombectomy alone. The main outcome endpoints of the study were the degree of recanalization and the 90-day clinical outcome. The safety endpoints were symptomatic intracerebral hemorrhage and all causes of mortality at 90 days.
Using univariate analysis, the rates of successful reperfusion (modified Thrombolysis in Cerebral Infarction grades 2B and 3) and favorable clinical outcome after 90 days were significantly higher after acute carotid stenting with antithrombotic therapy and thrombectomy compared with the group with thrombectomy alone. After adjusting for confounding variables, acute stenting with antithrombotic therapy was independently associated with successful recanalization (odds ratio: 2.4; 95% confidence interval: 1.25 to 4.59; p = 0.008). The rates of symptomatic intracerebral hemorrhage and 90-day mortality were comparable among all 4 treatment groups.
Acute stenting of the extracranial ICA with antithrombotic therapy in combination with intracranial thrombectomy is associated with higher recanalization rates in treatment of patients with acute stroke with tandem lesions.
本研究旨在确定急性串联性颅内和颅外颈内动脉（ICA）病变患者的最佳血管内治疗方法。
目前，对于急性串联性颅内和颅外颈内动脉病变患者的血管内治疗，尚没有理想的技术策略。
这是一项国际多中心登记研究，共纳入 482 例急性缺血性卒中合并串联性颅内和颅外 ICA 病变患者。所有患者均接受颅内血栓切除术及以下 4 种治疗策略之一：1）急性颅外 ICA 支架置入术联合抗栓治疗；2）急性颅外 ICA 支架置入术不联合抗栓治疗；3）颅外 ICA 球囊血管成形术；4）单纯颅内血栓切除术。研究的主要转归终点为再通程度和 90 天临床结局。安全性终点为症状性颅内出血和 90 天内的全因死亡率。
单因素分析显示，与单纯血栓切除术相比，抗栓治疗联合急性颈动脉支架置入术和血栓切除术的再通率（改良脑梗死溶栓分级 2B 和 3 级）和 90 天后的良好临床结局更高。在调整混杂因素后，抗栓治疗的急性颈动脉支架置入术与再通成功独立相关（比值比：2.4；95%置信区间：1.25 至 4.59；p=0.008）。4 种治疗组的症状性颅内出血发生率和 90 天死亡率相当。
急性颅外 ICA 支架置入术联合抗栓治疗与颅内血栓切除术联合治疗急性串联性颅内和颅外 ICA 病变患者可提高再通率。
