Division of Neurology, Centre Hospitalier de l'Université de Montréal, 900, rue St-Denis, R04-758 H2X 0A9 Montréal, Québec, Canada; Neurovascular Group, Axe Neurosciences, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 900, rue St-Denis, R04-758 H2X 0A9 Montréal, Québec, Canada; Department of Neurosciences, Faculté de Médecine, Université de Montréal, 900, rue St-Denis, R04-758 H2X 0A9 Montréal, Québec, Canada.
Division of Neurology, Centre Hospitalier de l'Université de Montréal, 900, rue St-Denis, R04-758 H2X 0A9 Montréal, Québec, Canada; Neurovascular Group, Axe Neurosciences, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 900, rue St-Denis, R04-758 H2X 0A9 Montréal, Québec, Canada; Department of Neurosciences, Faculté de Médecine, Université de Montréal, 900, rue St-Denis, R04-758 H2X 0A9 Montréal, Québec, Canada.
J Neuroradiol. 2020 Nov;47(6):416-420. doi: 10.1016/j.neurad.2019.08.003. Epub 2019 Sep 26.
The optimal management of patients with tandem lesions (TL), or cervical internal carotid artery (c-ICA) steno-occlusive pathology and ipsilateral intracranial occlusion, who are undergoing endovascular thrombectomy (EVT) remains unknown. We sought to establish the feasibility of a trial designed to address this question.
The Endovascular Acute Stroke Intervention (EASI) study was a single-centre randomized trial comparing EVT to medical therapy for large-vessel occlusion stroke. Patients with TL receiving EVT were randomly allocated to acute c-ICA stenting or no stenting. The primary outcome was the proportion of patients with a modified Rankin Scale (mRS) score of 0-2 at 90 days. Safety outcomes were symptomatic intracranial hemorrhage (sICH) at 24hours and mortality at 90 days.
Of 301 patients included in EASI between 2013 and 2018, 24 (8.0%) with TL were randomly allocated to acute stenting (n=13) or no stenting (n=11). Baseline characteristics were balanced. Eight (61.5%; 95% CI 35.5%-82.3%) and 7 (63.6%; 95% CI 35.4%-84.9%) patients, respectively, had a favorable outcome (mRS 0-2; P=1.0). One non-stented patient had a symptomatic intracerebral hemorrhage.
This pilot trial of patients with TL undergoing EVT suggests that a sufficiently powered larger TL trial comparing acute c-ICA stenting to no stenting is feasible.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02157532.
接受血管内血栓切除术（EVT）的串联病变（TL）或颈内动脉（c-ICA）狭窄闭塞性病变和同侧颅内闭塞患者的最佳治疗方法仍不清楚。我们旨在建立一项旨在解决这一问题的试验的可行性。
血管内急性卒中干预（EASI）研究是一项单中心随机试验，比较了 EVT 与大血管闭塞性卒中的药物治疗。接受 EVT 的 TL 患者被随机分配接受急性 c-ICA 支架置入术或不支架置入术。主要结局是 90 天时改良 Rankin 量表（mRS）评分 0-2 的患者比例。安全性结局为 24 小时症状性颅内出血（sICH）和 90 天时死亡率。
在 2013 年至 2018 年期间纳入 EASI 的 301 例患者中，24 例（8.0%）TL 患者被随机分配接受急性支架置入术（n=13）或不支架置入术（n=11）。基线特征平衡。分别有 8 例（61.5%；95%CI 35.5%-82.3%）和 7 例（63.6%；95%CI 35.4%-84.9%）患者的结局良好（mRS 0-2；P=1.0）。1 例未支架置入的患者发生症状性颅内出血。
这项接受 EVT 的 TL 患者的试验表明，一项比较急性 c-ICA 支架置入术与不支架置入术的大型 TL 试验具有足够的功率是可行的。
