Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
J Endovasc Ther. 2022 Oct;29(5):790-797. doi: 10.1177/15266028211064818. Epub 2021 Dec 12.
Endovascular treatment of atherosclerotic tandem occlusions in acute ischemic stroke (AIS) is a matter of debate. This article reports a single-center experience using an intermediate catheter with microballoon for treatment of tandem occlusions.
A total of 151 AIS patients with large vessel occlusion received endovascular therapy and a consecutive series of patients (n = 26) who suffered from tandem cervical intracranial occlusions were treated using the Passing Extracranial Artery Occlusion by Intermediate Catheter with Expanding Microballoon (PEACE) technique. Intracranial recanalization was achieved by aspiration or stent retriever and then emergency stenting was performed for extracranial internal carotid artery (ICA) lesion. Demographic, clinical characteristics, procedural details of endovascular therapy, and prognosis outcome were assessed. The outcomes of tandem occlusion group were compared with isolated intracranial occlusion group (n = 122) and previous studies.
As compared to isolated intracranial occlusion groups, only a few patients suffered from atrial fibrillation (7.7% vs 38.5%, p<0.01) in tandem occlusions group. A larger proportion of patients (61.5% vs 29.5%) had tandem occlusions in which extracranial ICA occlusion was combined with intracranial terminus occlusion in ICA (p<0.01). 46.2% of tandem occlusions patients achieved intracranial recanalization by aspiration alone versus 15.6% in patients with isolated intracranial occlusion (p<0.01). In tandem occlusion patients treated with PEACE, 92.3% achieved successful reperfusion (thrombolysis in cerebral infarct [TICI] ≥2b). The median time from puncture to recanalization was 51 minutes (interquartile range [IQR], 41-66). 67.6% favorable functional prognosis (modified Rankin score [mRS], 0-2) was seen, with 11.5% mortality and 3.8% of symptomatic intracerebral hemorrhage (sICH) at 90 days. These outcomes are all consistent or better than previously reported studies performed for tandem occlusion.
Endovascular therapy using the PEACE technique with intermediate catheter and lined expanding microballoon is safe, efficient, and fast in the treatment of atherosclerotic tandem occlusion patients.
急性缺血性脑卒中（AIS）中动脉粥样硬化性串联闭塞的血管内治疗仍存在争议。本文报道了使用中间导管和微球囊治疗串联闭塞的单中心经验。
151 例接受血管内治疗的大血管闭塞 AIS 患者中连续系列的 26 例患者（n=26）存在颈内颅内串联闭塞，采用Passing Extracranial Artery Occlusion by Intermediate Catheter with Expanding Microballoon（PEACE）技术进行治疗。抽吸或支架取栓器实现颅内再通，然后对颈内动脉（ICA）病变行紧急支架置入术。评估人口统计学、临床特征、血管内治疗程序细节和预后结果。将串联闭塞组的结果与孤立性颅内闭塞组（n=122）和既往研究进行比较。
与孤立性颅内闭塞组相比，串联闭塞组仅少数患者（7.7% vs. 38.5%，p<0.01）患有心房颤动。在串联闭塞中，颈内 ICA 闭塞与颅内 ICA 终末闭塞相结合的患者比例较大（61.5% vs. 29.5%，p<0.01）。单纯抽吸即可使 46.2%的串联闭塞患者实现颅内再通，而孤立性颅内闭塞患者为 15.6%（p<0.01）。在接受 PEACE 治疗的串联闭塞患者中，92.3%达到了成功再灌注（血栓溶解程度 [TICI]≥2b）。从穿刺到再通的中位时间为 51 分钟（四分位距[IQR]，41-66）。90 天内，67.6%的患者获得了良好的功能预后（改良 Rankin 评分[mRS]，0-2），死亡率为 11.5%，症状性颅内出血（sICH）发生率为 3.8%。这些结果均与或优于既往报道的串联闭塞治疗研究一致。
使用中间导管和带线扩张微球囊的 PEACE 技术治疗动脉粥样硬化性串联闭塞患者安全、有效且快速。
