Vu-Dang Luu, Nguyen Quang-Anh, Nguyen-Thi-Thu Trang, Tran Anh-Tuan, Le-Chi Cong, Le-Hoang Kien, Nguyen-Tat Thien, Nguyen-Huu An, Pham-Minh Thong, Chu-Dinh Thien, Chu Dinh-Toi
Radiology Faculty, Hanoi Medical University, Danang, Vietnam.
Radiology Center, Bach Mai University Hospital, Danang, Vietnam.
Ann Indian Acad Neurol. 2020 Jan-Feb;23(1):78-83. doi: 10.4103/aian.AIAN_464_18.
Tandem occlusive lesion, a major challenge for thrombectomy in acute anterior circulation strokes, is poorly represented in randomized trials. This study demonstrates the findings of thrombectomy in tandem occlusion and comparative analysis of two treatment groups (extracranial versus intracranial first subgroup).
We enrolled and divided 17 patients with acute tandem ischemic stroke who received endovascular treatment into two groups. Group 1 with completed (100%) internal carotid artery (ICA) occlusion was treated by an extracranial stent, whereas Group 2 with severe (70%-99%) ICA occlusion was prioritized with intracranial thrombectomy. Data of clinical parameters, imaging and angiographic results, periprocedural complications, and results after 3 months were collected and analyzed.
The mean age of patients was 70.2 ± 8.8 years, and males accounted for 94.1%. The National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT Score (ASPECTS) baseline were 16.6 ± 4.2 and 7.6 ± 1.1, respectively, with occlusive side was 52.9% on the right. Group 1 including ten cases (58.8%) was treated extracranial lesion with carotid stent before intracranial thrombectomy, and Group 2 with seven cases (41.2%) was prioritized intracranial thrombectomy. In total 17 procedures, there were ten stent retrievers (58.8%), four aspirations (23.5%), and three Solumbra (17.7%). No re-occlusion of carotid stent postoperation was recorded. The good revascularization (thrombolysis in cerebral infarction 2b-3) was archived in 82.4% of patients, while symptomatic hemorrhage was seen in 2 cases (11.8%). Three months after treatment, patients with favorable clinical outcome (Modified Rankin Scale ≤2) accounted for 47.1%.
Our study determined a promising outcome with reasonable good recanalization and clinical recovery for endovascular intervention in tandem ischemic. In the subgroup of treatment, "extracranial stent first" had more complex disease with completed ICA occlusion which required longer procedure time may lead to worse outcome.
串联闭塞性病变是急性前循环卒中血栓切除术面临的一项重大挑战，在随机试验中的代表性不足。本研究展示了串联闭塞血栓切除术的结果，并对两个治疗组（颅外优先与颅内优先亚组）进行了对比分析。
我们纳入了17例接受血管内治疗的急性串联缺血性卒中患者，并将其分为两组。第1组为颈内动脉（ICA）完全闭塞（100%），采用颅外支架治疗；第2组为ICA严重闭塞（70%-99%），优先进行颅内血栓切除术。收集并分析临床参数、影像学和血管造影结果、围手术期并发症以及3个月后的结果数据。
患者的平均年龄为70.2±8.8岁，男性占94.1%。美国国立卫生研究院卒中量表（NIHSS）和阿尔伯塔卒中项目早期CT评分（ASPECTS）基线分别为16.6±4.2和7.6±1.1，闭塞侧位于右侧的占52.9%。第1组包括10例（58.8%），在颅内血栓切除术之前先采用颈动脉支架治疗颅外病变；第2组有7例（41.2%），优先进行颅内血栓切除术。在总共17例手术中，使用了10次支架取栓器（58.8%）、4次抽吸（23.5%）和3次Solumbra技术（17.7%）。术后未记录到颈动脉支架再闭塞情况。82.4%的患者实现了良好的血管再通（脑梗死溶栓2b-3级），而有2例（11.8%）出现了症状性出血。治疗3个月后，临床预后良好（改良Rankin量表评分≤2）的患者占47.1%。
我们的研究确定了血管内介入治疗串联缺血性病变有良好的再通和临床恢复前景。在治疗亚组中，“先进行颅外支架治疗”的患者疾病更为复杂，ICA完全闭塞，手术时间更长，可能导致预后更差。
