Unit of Interventional Neuroradiology, Department of Neurology and Human Movement Sciences, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences, University of Siena, Azienda Ospedaliera Universitaria Senese, Santa Maria Alle Scotte Hospital, Viale M. Bracci 16, 53100, Siena, Italy.
Radiol Med. 2021 Jun;126(6):804-817. doi: 10.1007/s11547-020-01331-7. Epub 2021 Jan 27.
Acute ischemic stroke (AIS) due to tandem lesions (TLs) of extracranial Internal Carotid Artery and Anterior Cerebral Circulation are challenging for endovascular treatment (EVT). This study aims to evaluate feasibility, safety and efficacy of EVT for TLs' AIS, with or without emergent carotid artery stenting (eCAS), in a real-life scenario.
Retrospective review of prospectively collected non-randomized thrombectomy databases from five stroke centers between 2015 and 2019. Consecutive patients with TLs' AIS were selected. Clinical, neuroimage and procedure features, as well as antiplatelet therapy regimen, were evaluated. Primary outcome was 90-day mRS ≤ 2. Secondary outcomes included: mTICI score 2b-3, extracranial recanalization, procedural complications, symptomatic intracerebral hemorrhage (SICH) and 90-day mortality.
Two hundred twenty-seven patients were enrolled (67.8% males; mean age 65.9 ± 12.9 years). We obtained mTICI 2b-3 in 77.1%, extracranial recanalization in 86.8%, 90-day mRS (available in 201/227 cases) ≤ 2 in 49.8%. Procedural complications occurred in 16.7%, SICH in 9.7%; 90-day mortality rate (available in 201/227 cases) was 14.4%. The strongest predictors of good clinical outcome were young age (p < 0.0001), low baseline NIHSS (p = 0.008), high baseline ASPECTS (p < 0.0001), good collateral flow (p = 0.013) and extracranial recanalization (p = 0.001). The most significant predictors of SICH were low baseline ASPECTS (p < 0.0001), occurrence of complications (p < 0.0001) and eCAS (p = 0.002).
In our real-life series, the EVT for TLs' AIS was feasible, safe and effective in improving 90-day functional outcome with acceptable morbi-mortality rates. ECAS increased the risk of SICH, independently from the antiplatelet therapy regimen.
由于颈内动脉颅外段和大脑前循环的串联病变（TLs）导致的急性缺血性脑卒中（AIS），对血管内治疗（EVT）具有挑战性。本研究旨在评估在真实情况下，对 TLs 的 AIS 进行 EVT 的可行性、安全性和有效性，无论是否进行紧急颈动脉支架置入术（eCAS）。
回顾性分析了 2015 年至 2019 年期间来自五个卒中中心的前瞻性收集的非随机取栓数据库。选择了 TLs 的 AIS 连续患者。评估了临床、神经影像和程序特征，以及抗血小板治疗方案。主要结局为 90 天 mRS≤2。次要结局包括：mTICI 评分 2b-3、颅外再通、程序并发症、症状性颅内出血（SICH）和 90 天死亡率。
共纳入 227 例患者（67.8%为男性；平均年龄 65.9±12.9 岁）。我们获得了 77.1%的 mTICI 2b-3，86.8%的颅外再通，201/227 例可评估的 90 天 mRS（mRS）≤2 的为 49.8%。16.7%的患者发生了程序并发症，9.7%的患者发生了 SICH；201/227 例可评估的 90 天死亡率为 14.4%。良好临床结局的最强预测因素是年龄较轻（p<0.0001）、基线 NIHSS 较低（p=0.008）、基线 ASPECTS 较高（p<0.0001）、侧支循环良好（p=0.013）和颅外再通（p=0.001）。SICH 的最重要预测因素是基线 ASPECTS 较低（p<0.0001）、并发症发生（p<0.0001）和 eCAS（p=0.002）。
在我们的真实系列中，对 TLs 的 AIS 进行 EVT 是可行的、安全的，能够改善 90 天的功能结局，且死亡率和发病率可接受。ECAS 增加了 SICH 的风险，独立于抗血小板治疗方案。
