University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Freiburgstrasse 8, 3010, Bern, Switzerland.
Department of Neurology, University of Bern, Inselspital, Freiburgstrasse 8, 3010, Bern, Switzerland.
Cardiovasc Intervent Radiol. 2019 Jun;42(6):863-872. doi: 10.1007/s00270-019-02187-9. Epub 2019 Mar 11.
Data on the management of large vessel occlusion in patients with anterior circulation acute ischemic stroke (AIS) due to underlying intracranial stenosis are scarce. The aim of this retrospective study was to compare endovascular treatment and outcome in AIS patients with and without underlying stenosis of the M1 segment.
A total of 533 acute stroke patients with an isolated M1 occlusion who underwent mechanical thrombectomy between 02/2010 and 08/2017 were included. Underlying intracranial atherosclerotic stenosis (ICAS) was present in 10 patients (1.9%), whereas 523 patients (98.1%) had an embolic occlusion without stenosis.
There was no difference in age, admission National Institutes of Health Stroke Scale, risk factors, Alberta stroke program early CT score or collaterals between the groups. Procedure time (155 vs 40 min, P = 0.001) was significantly longer in the ICAS group where rescue stent-angioplasty was performed in all patients. There was no statistical difference in final modified thrombolysis in cerebral infarction score between both groups (70 vs 88%, P = 0.115). Favorable outcome (modified Rankin Scale ≤ 2) at 90 days was less frequent in patients with ICAS than in the embolic group (0 vs 49.4%, P = 0.004). The mortality rate tended to be higher in the ICAS group (44.4 vs 19.4%, P = 0.082).
In patients with AIS, rescue therapy with stent placement to treat underlying ICAS of the M1 segment is technically feasible; however, in our study, a significantly lower rate of favorable outcome was observed in these patients compared to those with thromboembolic M1 occlusions.
Level 3, non-randomized controlled study.
关于颅内狭窄导致前循环急性缺血性脑卒中（AIS）患者大血管闭塞的管理数据很少。本回顾性研究的目的是比较伴有和不伴有 M1 段狭窄的 AIS 患者的血管内治疗和结局。
共纳入 533 例 2010 年 2 月至 2017 年 8 月期间接受机械取栓的孤立 M1 闭塞的急性脑卒中患者。10 例（1.9%）存在颅内动脉粥样硬化性狭窄（ICAS），523 例（98.1%）存在无狭窄的栓塞性闭塞。
两组间的年龄、入院时国立卫生研究院卒中量表评分、危险因素、阿尔伯塔卒中项目早期 CT 评分或侧支循环均无差异。ICAS 组的手术时间（155 分钟比 40 分钟，P=0.001）显著延长，所有患者均行支架血管成形术补救治疗。两组最终改良脑梗死溶栓评分无统计学差异（70%比 88%，P=0.115）。90 天时 ICAS 组患者的预后良好（改良Rankin 量表评分≤2）比例明显低于栓塞组（0%比 49.4%，P=0.004）。ICAS 组死亡率有升高趋势（44.4%比 19.4%，P=0.082）。
在 AIS 患者中，采用支架置入术治疗 M1 段基础 ICAS 的挽救性治疗在技术上是可行的；然而，在我们的研究中，与血栓栓塞性 M1 闭塞患者相比，这些患者的预后良好率明显较低。
3 级，非随机对照研究。
