Kim Yong-Won, Kang Dong-Hun, Kim Yong-Sun, Hwang Yang-Ha
Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea.
Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea.
J Korean Neurosurg Soc. 2019 Mar;62(2):201-208. doi: 10.3340/jkns.2018.0144. Epub 2019 Feb 27.
In patients with internal carotid artery (ICA) occlusion, collateral middle cerebral artery (MCA) flow has a protective role against ischemia. However, some of these patients may experience initial major neurological deficits and major worsening on following days. Thus, we investigated the safety and efficacy of endovascular treatment (EVT) for ICA occlusion with collateral MCA flow by comparing clinical outcomes of medical treatment versus EVT.
The inclusion criteria were as follows : 1) acute ischemic stroke with ICA occlusion and presence of collateral MCA flow on transfemoral cerebral angiography (TFCA) and 2) hospital arrival within 12 hours from symptom onset. The treatment strategy was made by the attending physician based on the patient's clinical status and results of TFCA.
Eighty-one patients were included (30 medical treatment, 51 EVT). The EVT group revealed a high incidence of intracranial ICA occlusion, longer ipsilesional MCA contrast filling time, and a similar rate of favorable clinical outcome despite a higher mean baseline the National Institutes of Health Stroke Scale (NIHSS) score. By binary logistic regression analysis, intravenous recombinant tissue plasminogen activator and EVT were independent predictors of favorable clinical outcome. In subgroup analysis based on stroke etiology, the non-atherosclerotic group showed a higher baseline NIHSS score, higher incidence of EVT, and a higher rate of distal embolization during EVT in comparison with the atherosclerotic group.
In patients with ICA occlusion and collateral MCA flow, decisions regarding treatment strategy based on TFCA can help achieve favorable clinical outcomes. EVT strategy with respect to etiology of ICA occlusion might help achieve better angiographic outcomes.
在颈内动脉（ICA）闭塞患者中，大脑中动脉（MCA）侧支血流对缺血具有保护作用。然而，这些患者中的一些人可能会在最初出现严重的神经功能缺损，并在随后几天病情严重恶化。因此，我们通过比较药物治疗与血管内治疗（EVT）的临床结果，研究了针对有MCA侧支血流的ICA闭塞进行血管内治疗的安全性和有效性。
纳入标准如下：1）经股动脉脑血管造影（TFCA）显示为急性缺血性卒中且伴有ICA闭塞及MCA侧支血流，以及2）症状发作后12小时内入院。治疗策略由主治医师根据患者的临床状况和TFCA结果制定。
共纳入81例患者（30例接受药物治疗，51例接受EVT）。尽管平均基线美国国立卫生研究院卒中量表（NIHSS）评分较高，但EVT组颅内ICA闭塞发生率较高，同侧MCA造影剂充盈时间较长，且良好临床结局的发生率相似。通过二元逻辑回归分析，静脉注射重组组织型纤溶酶原激活剂和EVT是良好临床结局的独立预测因素。在基于卒中病因的亚组分析中，与动脉粥样硬化组相比，非动脉粥样硬化组基线NIHSS评分更高，EVT发生率更高，且EVT期间远端栓塞发生率更高。
在有ICA闭塞和MCA侧支血流的患者中，基于TFCA制定治疗策略的决策有助于取得良好的临床结局。针对ICA闭塞病因的EVT策略可能有助于获得更好的血管造影结果。
