Department of Radiology, Beaujon Hospital, AP-HP, 100 Boulevard du Général Leclerc, 92118, Clichy, Hauts-de-Seine, France.
INSERM U1148, LVTS, Paris, France.
Eur Radiol. 2022 Aug;32(8):5606-5615. doi: 10.1007/s00330-022-08660-3. Epub 2022 Mar 8.
To report the 3-year experience of endovascular revascularization of acute arterial mesenteric ischemia (AMI) from an intestinal stroke center unit (ISCU).
All data from patients admitted to the ISCU between January 2016 and January 2019 for arterial AMI who underwent endovascular recanalization were prospectively acquired and retrospectively analyzed. Patient demographics, clinical and laboratory characteristics at presentation, and CT scans were reviewed. The type (thrombolysis, thrombectomy, stenting) and the outcome of endovascular procedures (technical success or failure, complications) were noted. Care pathways were described focusing on post-procedural treatments (surgical revascularization, bowel resection) and the mortality rate was evaluated in subgroups.
Fifty-eight patients (34 men [59%], mean 69 ± 29 years) were included. Endovascular revascularization was technically successful in 51/58 (88%) patients, and 10 (17%) patients had post-procedural complications. Stenting and in situ thrombolysis were performed in most patients (n = 33 and n = 19, respectively). Thirty-two patients (55%) were recurrence-free and required no further treatment after the procedure, while 9 (16%), 5 (9%), and 5 (9%) patients underwent 2nd-line bowel resection, surgical revascularization, or both. Overall, 46 (79%), 45 (78%), and 34 patients (63%) were alive at 3 months, 1 year, and 3 years. No significant difference in survival was found in care pathways or baseline characteristics.
Endovascular revascularization is highly feasible for the treatment of arterial AMI, and is associated with an acceptable rate of complications. Results of endovascular revascularization shall only be interpreted as part of a multidisciplinary patient management strategy.
• Endovascular revascularization is highly feasible for the treatment of arterial AMI, and is associated with an acceptable rate of complications. • Several techniques are available to perform endovascular revascularization, and their use depends on the cause, the location, and the quality of underlying arteries of patients. • Results of endovascular revascularization shall only be interpreted in relation to its role in an integrated multidisciplinary and patient management strategy.
报告一家肠卒中中心单元（ISCU）对急性肠系膜动脉缺血性卒中（AMI）进行血管内再通治疗的 3 年经验。
前瞻性采集 2016 年 1 月至 2019 年 1 月期间因 AMI 入住 ISCU 并接受血管内再通的所有患者的数据，并进行回顾性分析。对患者的人口统计学、就诊时的临床和实验室特征以及 CT 扫描进行了回顾。记录了血管内治疗的类型（溶栓、血栓切除术、支架置入术）和结果（技术上的成功或失败、并发症）。重点介绍了术后治疗（手术血运重建、肠切除术）途径，并评估了亚组的死亡率。
共纳入 58 例患者（34 例男性[59%]，平均年龄 69 ± 29 岁）。51/58 例（88%）患者的血管内再通技术成功，10 例（17%）患者出现术后并发症。大多数患者接受了支架置入和原位溶栓治疗（分别为 n = 33 和 n = 19）。32 例（55%）患者无复发，且在术后无需进一步治疗，9 例（16%）、5 例（9%）和 5 例（9%）患者需要二线肠切除术、手术血运重建或两者均行。总的来说，3 个月、1 年和 3 年时的存活率分别为 46%（79%）、45%（78%）和 34%（63%）。在不同的治疗途径或基线特征方面，患者的存活率没有显著差异。
血管内再通治疗急性肠系膜动脉缺血性卒中具有很高的可行性，且并发症发生率可接受。血管内再通的结果应仅作为多学科患者管理策略的一部分进行解读。
• 血管内再通治疗急性肠系膜动脉缺血性卒中具有很高的可行性，且并发症发生率可接受。• 有多种技术可用于进行血管内再通，其使用取决于患者的病因、位置和潜在动脉的质量。• 血管内再通的结果应仅在与其在综合多学科和患者管理策略中的作用相关时进行解读。
