Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
Interventional Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
J Neurointerv Surg. 2021 Oct;13(10):889-893. doi: 10.1136/neurintsurg-2020-016754. Epub 2020 Oct 26.
The optimal treatment for medically refractory non-acute intracranial artery occlusion is uncertain, and endovascular recanalization remains a technical challenge. Here, a multicenter clinical experience of dual-roadmap guidance for endovascular recanalization of non-acute intracranial artery occlusion is reported, focusing on the technical feasibility and safety.
From January 2014 to December 2019, 52 consecutive patients with medically refractory atherosclerotic non-acute intracranial artery occlusion who underwent endovascular recanalization under dual-roadmap guidance in three large regional referral stroke centers were analyzed retrospectively. Four types of dual-roadmap technical schemes were applied during endovascular recanalization. The rates of technical success, periprocedural complications, any stroke or death within 30 days, and follow-up results were evaluated.
The technical success rate was 92.3% (48/52). The perioperative complication rate was 7.7% (4/52), and the rate of any stroke or death within 30 days was 3.8% (2/52). Asymptomatic dissection occurred in two patients, acute in-stent thrombosis followed by postoperative mild stroke (National Institutes of Health Stroke Scale (NIHSS) 3) in one patient, and death due to reperfusion hemorrhage after successful recanalization in one patient. The rate of stroke or death beyond 30 days was 6.5% (3/46). The median clinical follow-up period was 19 months, and the median imaging follow-up period was 12 months. The restenosis rate was 13.2% (5/38).
Endovascular recanalization of non-acute intracranial occlusions can be performed with a high rate of technical success and few complications with assistance of the dual-roadmap technique for navigation. Four types of dual-roadmap schemes provide technical references.
对于药物难治性非急性颅内动脉闭塞，最佳治疗方法尚不确定，血管内再通仍然是一项技术挑战。本研究报告了多中心应用双路径图指导技术对非急性颅内动脉闭塞进行血管内再通的临床经验，重点关注其技术可行性和安全性。
回顾性分析 2014 年 1 月至 2019 年 12 月在三个大型区域性转诊卒中中心接受双路径图指导下血管内再通的 52 例药物难治性动脉粥样硬化性非急性颅内动脉闭塞患者的临床资料。在血管内再通过程中应用了四种双路径图技术方案。评估技术成功率、围手术期并发症、30 天内任何卒中或死亡发生率以及随访结果。
技术成功率为 92.3%（48/52）。围手术期并发症发生率为 7.7%（4/52），30 天内任何卒中或死亡发生率为 3.8%（2/52）。两名患者发生无症状夹层，一名患者发生急性支架内血栓形成，随后术后轻度卒中（国立卫生研究院卒中量表（NIHSS）3 分），一名患者在成功再通后因再灌注出血死亡。30 天以上的卒中或死亡率为 6.5%（3/46）。中位临床随访时间为 19 个月，中位影像学随访时间为 12 个月。再狭窄率为 13.2%（5/38）。
在双路径图技术导航的辅助下，非急性颅内闭塞的血管内再通可以获得较高的技术成功率和较少的并发症。四种双路径图方案为技术提供了参考。
