Department of Neurology, CHRU Gui de Chauliac, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
Department of Neurology, Fondation Rothschild Hospital, Paris, France.
J Neurol. 2022 Aug;269(8):4383-4395. doi: 10.1007/s00415-022-11078-y. Epub 2022 Mar 31.
The best treatment for acute ischemic stroke (AIS) due to isolated cervical internal carotid artery occlusion (CICAO) (i.e., without associated occlusion of the circle of Willis) is still unknown. In this study, we aimed to describe EVT safety and clinical outcome in patients with CICAO.
We analyzed data of all consecutive patients, included in the Endovascular Treatment in Ischemic Stroke (ETIS) Registry between 2013 and 2020, who presented AIS and proven CICAO on angiogram and underwent EVT. We assessed carotid recanalization, procedural complications, National Institutes of Health Stroke Scale (NIHSS) at 24 h post-EVT, and 3-month favorable outcome (modified Rankin Scale, mRS ≤ 2 or equal to the pre-stroke value).
Forty-five patients were included (median age: 70 years; range: 62-82 years). The median NIHSS before EVT was 14 (9-21). Carotid stenting was performed in 23 (51%) patients. Carotid recanalization at procedure end and on control imaging was observed in 37 (82%) and 29 (70%) patients, respectively. At day 1 post-EVT, the NIHSS remained stable or decreased in 25 (60%) patients; 12 (29%) patients had early neurologic deterioration (NIHSS ≥ 4 points). The rate of procedural complications was 36%, including stent thrombosis (n = 7), intracranial embolism (n = 7), and symptomatic intracranial hemorrhage (n = 1). At 3 months, 18 (40%) patients had a favorable outcome, and 10 (22%) were dead.
Our study suggests that EVT in AIS patients with moderate/severe initial deficit due to CICAO led to high rate of recanalization at day 1, and a 40% rate of favorable outcome at 3 months. There was a high rate of procedural complication which is of concern. Randomized controlled trials assessing the superiority of EVT in patients with CICAO and severe deficits are needed.
孤立性颈内动脉闭塞（CICAO）（即 Willis 环无相关闭塞）引起的急性缺血性卒中（AIS）的最佳治疗方法仍不清楚。本研究旨在描述 CICAO 患者接受血管内治疗（EVT）的安全性和临床结局。
我们分析了 2013 年至 2020 年期间连续纳入血管内治疗急性缺血性卒中（ETIS）登记处的所有患者的数据，这些患者存在 AIS 并经血管造影证实 CICAO，并接受了 EVT。我们评估了颈动脉再通、程序并发症、EVT 后 24 小时的国立卫生研究院卒中量表（NIHSS）评分，以及 3 个月时的良好预后（改良 Rankin 量表评分，mRS≤2 或等于发病前值）。
共纳入 45 例患者（中位年龄：70 岁；范围：62-82 岁）。EVT 前 NIHSS 中位数为 14 分（9-21 分）。23 例（51%）患者行颈动脉支架置入术。37 例（82%）和 29 例（70%）患者分别在治疗结束时和在控制成像时实现了颈动脉再通。EVT 后第 1 天，25 例（60%）患者 NIHSS 稳定或降低；12 例（29%）患者出现早期神经功能恶化（NIHSS≥4 分）。程序并发症发生率为 36%，包括支架血栓形成（n=7）、颅内栓塞（n=7）和症状性颅内出血（n=1）。3 个月时，18 例（40%）患者预后良好，10 例（22%）患者死亡。
我们的研究表明，在 AIS 患者中，由于 CICAO 导致中重度初始缺损，EVT 导致了较高的第一天再通率，3 个月时的良好预后率为 40%。程序并发症发生率较高，令人担忧。需要随机对照试验来评估 EVT 在 CICAO 合并重度缺损患者中的优势。
