Kalmar Peter Janos, Tarkanyi Gabor, Nagy Csaba Balazs, Csecsei Peter, Lenzser Gabor, Bosnyak Edit, Karadi Zsofia Nozomi, Annus Adam, Szegedi Istvan, Buki Andras, Szapary Laszlo
Department of Neurology, Medical School, University of Pécs, 7623 Pécs, Hungary.
Department of Neurosurgery, Medical School, University of Pécs, 7623 Pécs, Hungary.
Life (Basel). 2021 May 20;11(5):458. doi: 10.3390/life11050458.
Acute ischemic strokes (AIS) due to tandem occlusion (TO) of intracranial anterior large vessel and concomitant extracranial internal carotid artery (EICA) are represent in 15-20% of all ischemic strokes. The endovascular treatment (EVT) strategy for those patients is still unclear. Although the intracranial mechanical thrombectomy (MT) is considered as a standard treatment approach, the EICA lesion stent necessity remains a matter of debate. We sought to assess the efficacy and safety of EVT in tandem lesions, particularly the EICA stenting management.
We retrospectively analyzed all patients with anterior circulation stroke associated with EICA lesion and receiving EVT in the three participated stroke centers between November 2017 and December 2020. Patients' data were collected from our prospective stroke registry (STAY ALIVE). Patients enrolled in our study were divided into two groups depending on whether acute carotid stenting (ACS) or balloon angioplasty only (BAO) technique was used. Our primary outcome was the 90-day functional outcome assessed by modified Rankin scale (mRS). Mortality at 90 days and symptomatic intracranial hemorrhage (sICH) were considered as secondary outcomes.
A total of 101 patients (age: 67 ± 10 years, 38.6% female) were enrolled in our study, including 29 (28.3%) BAO cases, and 72 (71.3%) patients treated with ACS. Patients in the BAO group were slightly older (70 ± 9 years vs. 66 ± 10 years, = 0.054), and had higher prevalence of comorbidities such as hypertension (100.0% vs. 59.4%, < 0.001). There was no significant difference in favorable outcomes (51.7% vs. 54.4%, = 0.808) between the groups. However, we observed a trend towards higher rates of sICH (8.3% vs. 3.4%, = 0.382) and 90-day mortality (23.5% vs. 13.8%, = 0.278) with significantly higher frequency of distal embolization (39.1% vs. 17.9%, = 0.043) in patients with ACS. In the overall population age ( = 0.013), atrial fibrillation (AF) ( = 0.008), National Institutes of Health Stroke Scale (NIHSS) baseline ( = 0.029), and successful recanalization ( = 0.023) were associated with favorable outcome.
Endovascular approach of EICA in addition to MT was safe and effective in tandem occlusion of anterior circulation. Furthermore, our results suggest that balloon angioplasty technique without acute stenting shows a comparable favorable outcome rate to ACS with moderately less hemorrhagic events and mortality rates.
颅内前循环大血管串联闭塞（TO）并伴有颅外颈内动脉（EICA）病变的急性缺血性卒中（AIS）占所有缺血性卒中的15% - 20%。这类患者的血管内治疗（EVT）策略仍不明确。尽管颅内机械取栓术（MT）被视为标准治疗方法，但EICA病变支架置入的必要性仍存在争议。我们旨在评估EVT治疗串联病变的疗效和安全性，尤其是EICA支架置入的处理方式。
我们回顾性分析了2017年11月至2020年12月期间在三个参与研究的卒中中心接受EVT治疗且伴有EICA病变的所有前循环卒中患者。患者数据来自我们的前瞻性卒中登记系统（STAY ALIVE）。根据是否使用急性颈动脉支架置入术（ACS）或仅球囊血管成形术（BAO）技术，将纳入本研究的患者分为两组。我们的主要结局是采用改良Rankin量表（mRS）评估的90天功能结局。90天死亡率和症状性颅内出血（sICH）被视为次要结局。
本研究共纳入101例患者（年龄：67±10岁，女性占38.6%），其中29例（28.3%）采用BAO治疗，72例（71.3%）采用ACS治疗。BAO组患者年龄稍大（70±9岁 vs. 66±10岁，P = 0.054），高血压等合并症的患病率更高（100.0% vs. 59.4%，P < 0.001）。两组间良好结局率无显著差异（51.7% vs. 54.4%，P = 0.808）。然而，但我们观察到ACS组患者的sICH发生率（8.3% vs. 3.4%，P = 0.382）和90天死亡率（23.5% vs. 13.8%，P = 0.278）有升高趋势，远端栓塞发生率显著更高（39.1% vs. 17.9%，P = 0.043）。在总体人群中，年龄（P = 0.013）、心房颤动（AF）（P = 0.008）、美国国立卫生研究院卒中量表（NIHSS）基线评分（P = 0.029）和成功再通（P = 0.023）与良好结局相关。
除MT外，EICA的血管内治疗方法对于前循环串联闭塞是安全有效的。此外，我们的结果表明，不进行急性支架置入的球囊血管成形术技术显示出与ACS相当的良好结局率，且出血事件和死亡率略低。
