Department of Neurosurgery, Junshin Hospital, 865-1 Befu-cho, Kakogawa City, Hyogo 675-0122, Japan.
Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe City, Hyogo, Japan.
J Stroke Cerebrovasc Dis. 2020 Jul;29(7):104824. doi: 10.1016/j.jstrokecerebrovasdis.2020.104824. Epub 2020 May 4.
Positive data from several randomized controlled trials (RCTs) of endovascular treatment (EVT) for acute ischemic stroke (AIS) patients with anterior circulation large vessel occlusion (ACLVO) have emerged. However, little evidence exists on EVT for acute extracranial internal carotid artery (EC-ICA) occlusion. We therefore analysed the outcome and effect of EVT on AIS due to ACLVO caused by EC-ICA occlusion, including tandem occlusion compared with that caused by pure intracranial artery occlusion.
A total of 135 consecutive AIS patients with ACLVO between July 2014 and December 2017 were identified. We retrospectively analysed the efficacy of EVT for ACLVO after introducing a stent retriever (SR). We classified ACLVO into the following categories: group A, intracranial artery occlusion without EC-ICA occlusion (pure intracranial artery occlusion), and group B, ipsilateral EC-ICA occlusion with/without intracranial artery occlusion.
In total, 65 patients were enrolled. Group A comprised 71% (46/65) of all cases. No difference was observed in terms of age, National Institute of Health Stroke Scale (NIHSS) score, Alberta Stroke Program Early Computed Tomography Score-Diffusion Weighted imaging (ASPECTS-DWI), several clinical time intervals, rate of successful revascularization (74% versus 84%), and rate of functional independence (42% versus 39%) between groups A and B. In all patients, an ASPECTS-DWI ≥6 and an onset-to-door time ≤6 h were associated with good outcome, whereas intracranial artery occlusion without EC-ICA occlusion (pure intracranial artery occlusion) was not.
The outcomes support the efficacy of EVT in stroke associated with acute EC-ICA occlusion. In the EVT of AIS due to ACLVO, there was no significant difference in the results between ipsilateral EC-ICA occlusion with/without intracranial artery occlusion and intracranial artery occlusion without EC-ICA occlusion (pure intracranial artery occlusion).
几项血管内治疗（EVT）治疗急性缺血性卒中（AIS）患者前循环大血管闭塞（ACLVO）的随机对照试验（RCT）均得出阳性结果。然而，对于急性颅外颈内动脉（EC-ICA）闭塞的 EVT 证据较少。因此，我们分析了 EVT 治疗因 EC-ICA 闭塞引起的 ACLVO 所致急性 AIS 的结果和效果，包括串联闭塞与单纯颅内动脉闭塞的比较。
共纳入 2014 年 7 月至 2017 年 12 月期间 135 例 ACLVO 连续 AIS 患者。我们回顾性分析了支架取栓（SR）引入后 EVT 治疗 ACLVO 的疗效。我们将 ACLVO 分为以下两类：A 组，无 EC-ICA 闭塞的颅内动脉闭塞（单纯颅内动脉闭塞），和 B 组，同侧 EC-ICA 闭塞伴/不伴颅内动脉闭塞。
共纳入 65 例患者。A 组占所有病例的 71%（46/65）。A 组和 B 组在年龄、美国国立卫生研究院卒中量表（NIHSS）评分、阿尔伯塔卒中项目早期 CT 评分-弥散加权成像（ASPECTS-DWI）、几个临床时间间隔、再通率（74%与 84%）和功能独立性率（42%与 39%）方面无差异。在所有患者中，ASPECTS-DWI≥6 和发病至门时间≤6 小时与良好预后相关，而无 EC-ICA 闭塞的颅内动脉闭塞（单纯颅内动脉闭塞）则无相关性。
结果支持 EVT 治疗急性 EC-ICA 闭塞相关卒中的疗效。在 ACLVO 所致 AIS 的 EVT 中，同侧 EC-ICA 闭塞伴/不伴颅内动脉闭塞与颅内动脉闭塞无 EC-ICA 闭塞（单纯颅内动脉闭塞）的结果无显著差异。
