Yu Jia Zhen, Sun Song Yun, Jon Sheen Jae, Goo Kim Joong, Hee Lee Deok
1 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
2 Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China.
Interv Neuroradiol. 2019 Aug;25(4):380-389. doi: 10.1177/1591019919826616. Epub 2019 Feb 27.
Symptomatic non-acute intracranial arterial occlusion (NAICO) is not uncommon. We report a single-center experience of the feasibility and safety of endovascular treatment of anterior circulation NAICO and summarize the outcomes of patient groups with successful or failed recanalization.
Patients who underwent endovascular therapy for intracranial arterial stenosis between January 2010 and May 2017 were retrospectively reviewed. Thirty-eight patients with symptomatic NAICO (symptom onset > 24 hours) in the anterior circulation were identified.
Successful recanalization was achieved in 76.3% of patients (29/38). Intraprocedural events occurred in 10.5% (4/38), including intima dissection ( = 1), parent artery rupture ( = 1) and acute in-stent thrombosis ( = 2). Mean follow-up duration after successful recanalization was 36.5 months. One patient died 68 days after the procedure because of a newly developed posterior circulation stroke. Acute reocclusion was observed in two patients (6.7%); subacute or delayed reocclusion was observed in three patients (10%). Good final outcome (modified Rankin Scale score ≤ 2) was achieved in 25 of 28 patients (89.3%) at three months. Mean follow-up duration of the nine patients with failed recanalization was 41.4 months. Three patients underwent extra-intracranial bypass for worsening symptoms. The other six patients showed stable or improved neurological status with antiplatelet medications. Good final outcome was achieved in eight of nine patients (88.9%) at three months.
Endovascular revascularization can be a viable option with an acceptable safety profile in selected patients with symptomatic NAICO in the anterior circulation. Further characterization of aborted cases would facilitate proper patient selection for endovascular treatment.
有症状的非急性颅内动脉闭塞（NAICO）并不少见。我们报告了单中心关于前循环NAICO血管内治疗的可行性和安全性的经验，并总结了再通成功或失败的患者组的结局。
回顾性分析2010年1月至2017年5月期间接受颅内动脉狭窄血管内治疗的患者。确定了38例前循环中有症状的NAICO患者（症状发作时间>24小时）。
76.3%的患者（29/38）实现了成功再通。术中事件发生率为10.5%（4/38），包括内膜夹层分离（n=1）、供血动脉破裂（n=1）和急性支架内血栓形成（n=2）。成功再通后的平均随访时间为36.5个月。1例患者在术后68天因新发后循环卒中死亡。2例患者（6.7%）出现急性再闭塞；3例患者（10%）出现亚急性或延迟性再闭塞。28例患者中有25例（89.3%）在3个月时获得了良好的最终结局（改良Rankin量表评分≤2）。9例再通失败患者的平均随访时间为41.4个月。3例患者因症状恶化接受了颅内外搭桥手术。其他6例患者使用抗血小板药物后神经功能状态稳定或改善。9例患者中有8例（88.9%）在3个月时获得了良好的最终结局。
对于前循环中有症状的NAICO的选定患者，血管内血运重建可能是一种可行的选择，且安全性可接受。对失败病例的进一步特征分析将有助于为血管内治疗选择合适的患者。
