Yan Yazhou, Du Li, He Xiliang, Huang Qinghai, Pan Yuan, Xin Tao
Stroke Center of 971 Hospital of PLA, Qingdao, 266071, China.
Department of Neurosurgery of Changhai Hospital affiliated to the Naval Military Medical University, Shanghai, China.
Chin Neurosurg J. 2022 Sep 1;8(1):22. doi: 10.1186/s41016-022-00292-2.
Endovascular treatment (EVT) for acute ischemic stroke with an occlusion of the M1 segment due to intracranial atherosclerotic severe stenosis (ICASS) remains challenging. This study aimed to evaluate the safety and efficacy of EVT for ICASS-related M1 acute occlusion.
We retrospectively reviewed all patients with an ICASS-related M1 acute occlusion who underwent EVT at our institution between January 2015 and December 2020. Clinical presentation, baseline characteristics, angiographic and clinical results, technical feasibility, perioperative complications, and follow-up results were evaluated.
Twenty-two patients with ICASS-related M1 acute occlusion were included. Eight patients (36.4%) received bridging therapy, and the other 14 patients (63.6%) directly underwent EVT. Fifteen patients (68.2%) treated with balloon dilations and stenting as rescue treatment. Six patients (27.3%) received single balloon angioplasty, and 5 of these patients were treated with staged stenting. One case (4.5%) failed recanalization at the first EVT, and successful revascularization was achieved a month later. The mean procedure time was 67.2 ± 20.8 min. Successful revascularization (mTICI ≥ 2b) was achieved in 95.5% (21/22) of patients. Perioperative complications developed in two patients (9.1%) including one hemorrhagic event and one thromboembolic event. Angiographic follow-up was available in 20 patients (90.9%) at an average of 8.6 ± 3.0 months. The degree of stenosis was worse (10-30%) in 6 cases (30%) compared with the initial outcomes. The favorable outcomes (mRS ≤ 2) at 3-month follow-up was achieved in 19 patients (86.4%).
ICASS-related occlusion in the M1 segment often required a rescue therapy including balloon angioplasty with/without stenting, and this treatment strategy was safe and effective. But single balloon angioplasty at the first EVT generally cannot achieve satisfactory results and often needed staged stenting treatment.
对于因颅内动脉粥样硬化严重狭窄（ICASS）导致M1段闭塞的急性缺血性卒中，血管内治疗（EVT）仍然具有挑战性。本研究旨在评估EVT治疗ICASS相关M1急性闭塞的安全性和有效性。
我们回顾性分析了2015年1月至2020年12月期间在我院接受EVT治疗的所有ICASS相关M1急性闭塞患者。评估了临床表现、基线特征、血管造影和临床结果、技术可行性、围手术期并发症及随访结果。
纳入22例ICASS相关M1急性闭塞患者。8例患者（36.4%）接受了桥接治疗，另外14例患者（63.6%）直接接受了EVT。15例患者（68.2%）接受球囊扩张和支架置入作为补救治疗。6例患者（27.3%）接受了单纯球囊血管成形术，其中5例患者接受了分期支架置入治疗。1例患者（4.5%）在首次EVT时再通失败，1个月后实现了成功的血管再通。平均手术时间为67.2±20.8分钟。95.5%（21/22）的患者实现了成功的血管再通（mTICI≥2b）。2例患者（9.1%）发生围手术期并发症，包括1例出血事件和1例血栓栓塞事件。20例患者（90.9%）进行了血管造影随访，平均随访时间为8.6±3.0个月。与初始结果相比，6例患者（30%）的狭窄程度加重（10%-30%）。19例患者（86.4%）在3个月随访时获得了良好的预后（mRS≤2）。
ICASS相关的M1段闭塞通常需要包括球囊血管成形术（伴或不伴支架置入）的补救治疗，且这种治疗策略是安全有效的。但首次EVT时单纯球囊血管成形术一般无法取得满意效果，常需分期支架置入治疗。
