Interventional Neurorradiology Department, University Hospital Virgen del Rocio.
Stroke Research Program, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville.
J Atheroscler Thromb. 2023 Jun 1;30(6):636-648. doi: 10.5551/jat.63560. Epub 2022 Aug 21.
Carotid reocclusion (CRO) after mechanical thrombectomy (MT) in acute ischemic stroke (AIS) due to tandem lesion (TL) or isolated internal carotid occlusion (ICO) is associated with worse clinical outcomes. Our aim was to analyze the predictors and clinical impact of CRO.
A retrospective single-center analysis of all patients with anterior circulation strokes who underwent MT prospectively included in a registry between 2017 and 2020 was performed. ICO and TL as stroke causes were included. Stent deployment was left to the discretion of the interventionist. All patients received at least intravenous aspirin during MT. CRO was assessed using ultrasound within the first 24 h after MT. Efficacy and safety of stenting were assessed.
Among 1304 AIS cases, 218 (16.7%) were related to TL or ICO. Of them, 5% (n=11) were associated with internal CRO 24 h after the endovascular procedure. After adjusting per confounders, multivariate analysis showed that the independent variables associated with CRO were the TICI recanalization grade [TICI 2b-3; OR 0.1, 95% confidence interval (CI) 0.01-0.89, p=0.040], pial collateral circulation presence (OR 0.09, 95% CI 0.02-0.45, p=0.03), stent deployment during MT (OR 0.17, 95% CI 0.03-0.84, p=0.030), and general anesthesia use (OR 2.92, 95% CI 1.13-7.90, p=0.034). CRO showed a trend toward worst outcomes (modified Rankin scale 3-6) at 3 months (OR 3.4, 95% CI 0.96-12, p=0.057). After multivariate analysis, variables independently associated with worse outcomes at 90 days were intrastent platelet aggregation phenomena during endovascular therapy, admission National Institute of Health Stroke Scale, and age. Conversely, intravenous thrombolysis and TICI 2b-3 recanalization grade were identified as independent predictors of good outcomes at 90 days.
CRO has a relevant clinical impact in our study, associating lower rates of good functional outcomes at 3 months. Independent factors of CRO were the recanalization degree, presence of pial collateral circulation, use of a stent as a protective factor, and use of general anesthesia during thrombectomy.
急性缺血性脑卒中（AIS）患者因串联病变（TL）或孤立性颈内动脉闭塞（ICO）而行机械血栓切除术（MT）后发生颈动脉再闭塞（CRO）与临床结局较差相关。本研究旨在分析 CRO 的预测因素和临床影响。
对 2017 年至 2020 年期间前瞻性纳入登记处的所有接受 MT 的前循环脑卒中患者进行回顾性单中心分析。纳入 ICO 和 TL 作为卒中病因。支架置入由介入医生决定。所有患者在 MT 期间至少接受静脉内阿司匹林治疗。MT 后 24 小时内使用超声评估 CRO。评估支架置入的疗效和安全性。
在 1304 例 AIS 病例中，218 例（16.7%）与 TL 或 ICO 有关。其中，5%（n=11）在血管内手术后 24 小时内与颈内 CRO 相关。调整混杂因素后，多变量分析表明，与 CRO 相关的独立变量包括 TICI 再通分级[TICI 2b-3；OR 0.1，95%置信区间（CI）0.01-0.89，p=0.040]、软脑膜侧支循环存在（OR 0.09，95%CI 0.02-0.45，p=0.03）、MT 期间支架置入（OR 0.17，95%CI 0.03-0.84，p=0.030）和全身麻醉的使用（OR 2.92，95%CI 1.13-7.90，p=0.034）。CRO 在 3 个月时表现出最差结局（改良 Rankin 量表 3-6）的趋势（OR 3.4，95%CI 0.96-12，p=0.057）。多变量分析后，与 90 天不良结局相关的变量为血管内治疗期间支架内血小板聚集现象、入院时国立卫生研究院卒中量表评分和年龄。相反，静脉溶栓和 TICI 2b-3 再通分级被确定为 90 天良好结局的独立预测因素。
在本研究中，CRO 具有显著的临床影响，与 3 个月时较低的良好功能结局相关。CRO 的独立因素是再通程度、软脑膜侧支循环的存在、支架作为保护因素的使用以及血栓切除术期间全身麻醉的使用。
