Yi Tingyu, Zhan Alai, Wu Yanmin, Li Yimin, Zheng Xiufen, Lin Dinglai, Lin Xiaohui, Pan Zhinan, Chen Rongcheng, Parsons Mark, Chen Wenhuo, Lin Longting
Cerebrovascular and Neuro-Intervention Department, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China.
Radiology Department, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China.
Brain Sci. 2022 Jul 22;12(8):966. doi: 10.3390/brainsci12080966.
Previous studies showed that acute reocclusion after endovascular therapy is related to residual stenosis. However, we observed that reperfusion status but not residual stenosis severity is related to acute reocclusion. This study aimed to assess which factor mention above is more likely to be associated with artery reocclusion after endovascular treatment.
This study included 86 acute ischemic stroke patients who had middle cerebral artery (MCA) atherosclerotic occlusions and received endovascular treatment within 24 h of a stroke. The primary outcomes included intraprocedural reocclusion assessed during endovascular treatment and delayed reocclusion assessed through follow-up angiography.
Of the 86 patients, the intraprocedural reocclusion rate was 7.0% (6/86) and the delayed reocclusion rate was 2.3% (2/86). Regarding intraprocedural occlusion, for patients with severe residual stenosis, patients with successful thrombectomy reperfusion showed a significantly lower rate than unsuccessful thrombectomy reperfusion (0/30 vs. 6/31, = 0.003); on the other hand, for patients with successful thrombectomy reperfusion, patients with severe residual stenosis showed no difference from those with mild to moderate residual stenosis in terms of intraprocedural occlusion (0/30 vs. 0/25, = 1.00). In addition, after endovascular treatment, all patients achieved successful reperfusion. There was no significant difference in the delayed reocclusion rate between patients with severe residual stenosis and those with mild to moderate residual stenosis (2/25 vs. 0/61, = 0.085).
Reperfusion status rather than residual stenosis severity is associated with artery reocclusion after endovascular treatment. Once successful reperfusion was achieved, the reocclusion occurrence was fairly low in MCA atherosclerosis stroke patients, even with severe residual stenosis.
既往研究表明血管内治疗后的急性再闭塞与残余狭窄有关。然而，我们观察到再灌注状态而非残余狭窄严重程度与急性再闭塞有关。本研究旨在评估上述哪个因素更可能与血管内治疗后动脉再闭塞相关。
本研究纳入了86例患有大脑中动脉（MCA）动脉粥样硬化闭塞且在卒中后24小时内接受血管内治疗的急性缺血性卒中患者。主要结局包括血管内治疗期间评估的术中再闭塞以及通过随访血管造影评估的延迟再闭塞。
86例患者中，术中再闭塞率为7.0%（6/86），延迟再闭塞率为2.3%（2/86）。关于术中闭塞，对于残余狭窄严重的患者，血栓切除术再灌注成功的患者发生率显著低于再灌注不成功的患者（0/30对6/31，P = 0.003）；另一方面，对于血栓切除术再灌注成功的患者，残余狭窄严重的患者与残余狭窄轻度至中度的患者在术中闭塞方面无差异（0/30对0/25，P = 1.00）。此外，血管内治疗后，所有患者均实现了成功再灌注。残余狭窄严重的患者与残余狭窄轻度至中度的患者之间延迟再闭塞率无显著差异（2/25对0/61，P = 0.085）。
血管内治疗后动脉再闭塞与再灌注状态而非残余狭窄严重程度有关。一旦实现成功再灌注，即使存在严重残余狭窄，MCA动脉粥样硬化性卒中患者的再闭塞发生率也相当低。
