From the Departments of Interventional Neuroradiology (F.G., X.S., Z.R.M.), Beijing Tiantan Hospital
From the Departments of Interventional Neuroradiology (F.G., X.S., Z.R.M.), Beijing Tiantan Hospital.
AJNR Am J Neuroradiol. 2021 Jan;42(2):299-305. doi: 10.3174/ajnr.A6928. Epub 2020 Dec 24.
The optimal treatment for symptomatic nonacute intracranial ICA occlusion is uncertain, and endovascular recanalization remains a technical challenge. Our purpose was to report multicenter clinical results of endovascular recanalization for medically refractory, nonacute, intracranial ICA occlusion and to propose a new angiographic classification to explore which subgroups of patients are most amenable to this treatment.
From January 2015 to December 2019, thirty-six consecutive patients who underwent endovascular recanalization for refractory, nonacute, atherosclerotic intracranial ICA occlusion at 3 stroke centers were analyzed retrospectively. The patients were divided into 3 types according to an angiographic classification. Rates of technical success, periprocedural complications, and any stroke or death within 30 days along with follow-up results were evaluated.
The overall technical success rate was 80.6% (29/36), and the rate of any stroke or death within 30 days was 16.7% (6/36). The recanalization success rate gradually decreased from type I to type III in the 3 classification groups (92.9%, 81.3%, and 50%, = .038), and the opposite was true of the perioperative complication rates (7.1%, 18.8%, and 50%, = .038). Type I lesions showed favorable recanalization effects, 92.9% technical success rates, and 7.1% perioperative complications.
Endovascular recanalization for nonacute atherosclerotic intracranial ICA occlusion is technically feasible, especially in patients with type I lesions, and could offer an alternative option for patients with recurrent ischemic symptoms despite aggressive medical therapy. The angiographic classification proposed is conducive to the selection of suitable patients and difficulty in grading.
症状性非急性颅内颈内动脉（ICA）闭塞的最佳治疗方法尚不确定，血管内再通仍然是一项技术挑战。我们的目的是报告 3 家卒中中心采用血管内再通治疗药物难治性、非急性、颅内 ICA 闭塞的多中心临床结果，并提出一种新的血管造影分类，以探讨哪些亚组患者最适合这种治疗方法。
回顾性分析 2015 年 1 月至 2019 年 12 月在 3 家卒中中心接受血管内再通治疗的 36 例药物难治性、非急性、动脉粥样硬化性颅内 ICA 闭塞患者。根据血管造影分类，患者分为 3 型。评估技术成功率、围手术期并发症、30 天内任何卒中和死亡发生率以及随访结果。
总体技术成功率为 80.6%（29/36），30 天内任何卒中和死亡发生率为 16.7%（6/36）。3 个分类组的再通成功率逐渐从 I 型降低到 III 型（92.9%、81.3%和 50%，=0.038），而围手术期并发症发生率则相反（7.1%、18.8%和 50%，=0.038）。I 型病变的再通效果较好，技术成功率为 92.9%，围手术期并发症发生率为 7.1%。
血管内再通治疗非急性动脉粥样硬化性颅内 ICA 闭塞是可行的，特别是对于 I 型病变患者，对于尽管进行了积极的药物治疗但仍有复发性缺血症状的患者，可提供一种替代治疗选择。提出的血管造影分类有利于选择合适的患者和分级难度。
