血管内治疗颈内动脉夹层所致急性缺血性脑卒中合并串联病变患者：一项多中心经验。
Endovascular treatment of patients with acute ischemic stroke and tandem occlusion due to internal carotid artery dissection: A multicenter experience.
机构信息
Diagnostic Imaging Unit, Department of Biomedicine and Prevention, 9318University of Rome Tor Vergata, Italy.
Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Italy.
出版信息
Neuroradiol J. 2023 Feb;36(1):86-93. doi: 10.1177/19714009221108673. Epub 2022 Jun 14.
BACKGROUND
The optimal management of patients with acute ischemic stroke (AIS) due to tandem occlusion (TO) and underlying carotid dissection (CD) remains unclear.
OBJECTIVE
We present our multicenter-experience of endovascular treatment (EVT) approach used and outcomes for AIS patients with CD-related TO (CD-TO).
METHODS
Consecutive AIS patients underwent EVT for CD-TO at five Italian Neuro-interventional Tertiary Stroke Centers were retrospectively identified. TO from atherosclerosis and other causes of, were excluded from the final analysis. Primary outcome was successful (mTICI 2b-3) and complete reperfusion (mTICI 3); secondary outcome was patients' 3-months functional independence (mRS≤2).
RESULTS
Among 214 AIS patients with TO, 45 presented CD-TO. Median age was 54 years (range 29-86), 82.2% were male. Age <65 years ( < 0.0001), lower baseline NIHSS score ( = 0.0002), and complete circle of Willis ( = 0.0422) were associated with mRS ≤ 2 at the multivariate analysis. Comparisons between antegrade and retrograde approaches resulted in differences for baseline NIHSS scores ( = 0.001) and number of EVT attempts per-procedure ( = 0.001). No differences in terms of recanalization rates were observed between antegrade and retrograde EVT approaches ( = 0.811) but higher rates of mTICI3 revascularization was observed with the retrograde compared to the antegrade approach (78.6% vs 73.3%), anyway not statistically significant. CD management technique (angioplasty vs aspiration vs emergent stenting) did not correlate with 3-months mRS≤2.
CONCLUSION
AIS patients with CD-TO were mostly treated with the retrograde approach with lower number of attempts per-procedure but it offered similar recanalization rates compared with the antegrade approach. Emergent carotid artery stenting (CAS) proved to be safe for CD management but it does not influence 3-months patients' clinical outcomes.
背景
串联性闭塞（TO）和潜在颈动脉夹层（CD）导致的急性缺血性脑卒中（AIS）患者的最佳治疗方案仍不明确。
目的
我们介绍了意大利五个神经介入治疗三级卒中中心对 CD 相关 TO（CD-TO）患者进行血管内治疗（EVT）的经验。
方法
回顾性分析了在这五个意大利神经介入治疗三级卒中中心接受 EVT 治疗 CD-TO 的连续 AIS 患者。最终分析排除了由动脉粥样硬化和其他原因引起的 TO 患者。主要结局为成功（mTICI 2b-3）和完全再灌注（mTICI 3）；次要结局为患者 3 个月时的功能独立性（mRS≤2）。
结果
在 214 例 TO 患者中，45 例为 CD-TO。中位年龄为 54 岁（范围 29-86 岁），82.2%为男性。年龄<65 岁（<0.0001）、较低的基线 NIHSS 评分（=0.0002）和完整的 Willis 环（=0.0422）与多变量分析中的 mRS≤2 相关。顺行和逆行方法之间的比较在基线 NIHSS 评分（=0.001）和每个手术的 EVT 尝试次数（=0.001）方面存在差异。顺行和逆行 EVT 方法之间在再通率方面无差异（=0.811），但逆行方法较顺行方法有更高的 mTICI3 血管再通率（78.6% vs 73.3%），但差异无统计学意义。CD 管理技术（血管成形术 vs 抽吸 vs 紧急支架置入）与 3 个月 mRS≤2 无相关性。
结论
CD-TO 的 AIS 患者主要采用逆行方法治疗，每个手术的尝试次数较少，但与顺行方法相比，再通率相似。紧急颈动脉支架置入术（CAS）在 CD 管理方面被证明是安全的，但它并不影响 3 个月患者的临床结局。
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