Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
World Neurosurg. 2022 Oct;166:e306-e312. doi: 10.1016/j.wneu.2022.07.001. Epub 2022 Jul 7.
The standard rescue modality for patients with intracranial atherosclerotic stenosis after failed mechanical thrombectomy (MT) is not well established. We evaluated the safety and efficacy of balloon dilation in combination with tirofiban as the first-line salvage therapy when MT failed in these patients.
We retrospectively analyzed the records of 47 patients admitted between January 2018 and June 2021, with middle cerebral artery atherosclerotic occlusion, who underwent balloon angioplasty in combination with tirofiban as the first-line salvage therapy after the failure of MT. The recanalization outcome, procedure-related complications, symptomatic intracranial hemorrhage, and functional outcome at 90 days were reviewed.
Recanalization with a modified Thrombolysis in Cerebral Infarction grade of 2b-3 was achieved in 41 (87.2%) of the 47 patients. Acute stents were deployed in another 6 patients who did not achieve successful re-perfusion after balloon angioplasty. Successful recanalization was achieved in 3 of them. One patient (2.1%, 1/47) experienced re-occlusion several days later due to the withdrawal of antiplatelet therapy for parenchymal hematoma. Seven patients (14.9%, 7/47) underwent stent angioplasty in the stable stage (range: 1-2 months) because severe residual stenosis was detected on follow-up imaging. There was only one event of periprocedural complication, namely ectopic migration of emboli. The good functional outcome rate was 55.3% (26/47), without the events of symptomatic intracranial hemorrhage and mortality.
Balloon angioplasty in combination with tirofiban is safe and effective for middle cerebral artery atherosclerotic occlusion after the failure of MT.
机械血栓切除术（MT）失败后颅内动脉粥样硬化性狭窄患者的标准抢救模式尚未确立。我们评估了在这些患者 MT 失败后，采用球囊扩张联合替罗非班作为一线挽救治疗的安全性和有效性。
我们回顾性分析了 2018 年 1 月至 2021 年 6 月期间收治的 47 例大脑中动脉粥样硬化闭塞患者的记录，这些患者在 MT 失败后采用球囊血管成形术联合替罗非班作为一线挽救治疗。回顾了再通结果、与操作相关的并发症、症状性颅内出血和 90 天的功能结局。
47 例患者中有 41 例（87.2%）达到改良血栓溶解脑梗死分级 2b-3 的再通。在球囊血管成形术未能成功再灌注的 6 例患者中，又放置了急性支架。其中 3 例成功再通。1 例（2.1%，1/47）因脑实质血肿行抗血小板治疗停药后数天再次闭塞。7 例（14.9%，7/47）在稳定期（1-2 个月）行支架血管成形术，因为随访影像学检查发现严重残余狭窄。只有 1 例发生围手术期并发症，即栓子异位迁移。良好的功能结局率为 55.3%（26/47），无症状性颅内出血和死亡率事件。
球囊血管成形术联合替罗非班治疗 MT 失败后的大脑中动脉粥样硬化性闭塞是安全有效的。
