Yi Ho Jun, Sung Jae Hoon, Lee Dong Hoon
Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
J Korean Neurosurg Soc. 2021 Mar;64(2):198-206. doi: 10.3340/jkns.2020.0146. Epub 2021 Feb 26.
The low-profile Neuroform Atlas stent can be deployed directly without an exchange maneuver by navigating into the Gateway balloon. This retrospective study assessed the safety and efficacy of Neuroform Atlas stenting as a rescue treatment after failure of mechanical thrombetomy (MT) for large artery occlusion.
Between June 2018 and December 2019, a total of 31 patients underwent Neuroform Atlas stenting with prior Gateway balloon angioplasty after failure of conventional MT caused by residual intracranial atherosclerotic stenosis (ICAS). Primary outcomes were successful recanalization and patency of the vessel 24 hours after intervention. Secondary outcomes were vessel patency after 14 days and 3-month modified Rankin Scale. Peri-procedural complications, intracerebral hemorrhage (ICH), and 3-month mortality were reviewed.
With a 100% of successful recanalization, median value of stenosis was reduced from 79.0% to 23.5%. Twenty-eight patients (90.3%) showed tolerable vessel patency after 14 days. New infarctions occurred in three patients (9.7%) over a period of 14 days; two patient (6.5%) underwent stent occlusion at 24 hours, and the other patient (3.2%) with delayed stent occlusion had a non-symptomatic dot infarct. There were no peri-procedural complications. Two patients (6.5%) developed an ICH immediately after the procedure with one of them is symptomatic.
Neuroform Atlas stenting seems to be an effective and safe rescue treatment modality for failed MT with residual ICAS, by its high successful recanalization rate with tolerable patency, and low peri-procedural complication rate. Further multicenter and randomized controlled trials are needed to confirm our findings.
低调的Neuroform Atlas支架可通过导入Gateway球囊直接展开，无需进行交换操作。本回顾性研究评估了Neuroform Atlas支架置入术作为大动脉闭塞机械取栓术（MT）失败后的补救治疗的安全性和有效性。
在2018年6月至2019年12月期间，共有31例患者在传统MT因残留颅内动脉粥样硬化狭窄（ICAS）失败后，先行Gateway球囊血管成形术，然后进行Neuroform Atlas支架置入术。主要结局为干预后24小时血管成功再通及通畅情况。次要结局为14天后血管通畅情况及3个月改良Rankin量表评分。回顾了围手术期并发症、脑出血（ICH）及3个月死亡率。
再通成功率为100%，狭窄中位数从79.0%降至23.5%。28例患者（90.3%）在14天后显示血管通畅情况可耐受。14天内有3例患者（9.7%）出现新的梗死；2例患者（6.5%）在24小时时发生支架闭塞，另1例患者（3.2%）延迟支架闭塞，有一个无症状点状梗死灶。无围手术期并发症。2例患者（6.5%）术后立即发生ICH，其中1例有症状。
Neuroform Atlas支架置入术似乎是MT失败合并残留ICAS的一种有效且安全的补救治疗方式，因其再通成功率高、通畅情况可耐受且围手术期并发症发生率低。需要进一步的多中心随机对照试验来证实我们的发现。
