Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA.
Medical University of South Carolina, Charleston, South Carolina, USA.
Neurosurgery. 2023 Jun 1;92(6):1155-1162. doi: 10.1227/neu.0000000000002338. Epub 2023 Jan 9.
Symptomatic intracranial atherosclerotic disease (sICAD) is estimated to cause 10% of strokes annually in the United States. However, treatment remains a challenge with several different stenting options studied in the past with unfavorable results.
To report the 30-day stroke and/or death rate associated with intracranial stent placement for sICAD using Resolute Onyx Zotarolimus-Eluting Stent (RO-ZES) and provide a comparison with the results of Stenting Versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial.
Prospectively maintained databases across 8 stroke centers were used to identify adult patients treated with RO-ZES for sICAD between January 2019 and December 2021. Primary end point was composite of 30-day stroke, intracerebral hemorrhage, and/or death. Propensity score matching was performed using age, hypertension, lipid disorder, cigarette smoking, and symptomatic target vessel to create a matched group for comparison between RO-ZES and the SAMMPRIS medical management and treatment groups (SAMMPRIS percutaneous angioplasty and stenting [S-PTAS]).
A total of 132 patients met the inclusion criteria for analysis (mean age: 64.2 years). Mean severity of stenosis was 81.4% (±11.4%). A total of 4 (3.03%) stroke and/or deaths were reported within 30 days of treatment in the RO-ZES group compared with 6.6% in the SAMMPRIS medical management group (OR [odds ratio] 2.26, 95% CI 0.7-9.56, P = .22) and 15.6% in the S-PTAS group (OR 5.9, 95% CI 2.04-23.4, P < .001). Propensity score match analysis of 115 patients in each group demonstrated 30-day stroke and/or death rate of 2.6% in the RO-ZES group and 15.6% in the S-PTAS group (OR 6.88, 95% CI 1.92-37.54, P < .001).
Patients treated with RO-ZES had a relatively low 30-day stroke and/or death rate compared with the S-PTAS group. Further large-scale prospective studies are warranted to evaluate the safety and efficacy of RO-ZES for the treatment of sICAD.
据估计，在美国，症状性颅内动脉粥样硬化性疾病（sICAD）每年导致 10%的中风。然而，由于过去研究过几种不同的支架置入治疗方法，结果并不理想，因此治疗仍然是一个挑战。
报告使用 Resolute Onyx Zotarolimus-Eluting Stent（RO-ZES）治疗 sICAD 的颅内支架置入术后 30 天内的中风和/或死亡率，并与 Stenting Versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis（SAMMPRIS）试验的结果进行比较。
使用 8 个卒中中心的前瞻性维护数据库，确定 2019 年 1 月至 2021 年 12 月期间接受 RO-ZES 治疗 sICAD 的成年患者。主要终点是 30 天内中风、颅内出血和/或死亡的复合事件。使用年龄、高血压、血脂异常、吸烟和症状性靶血管进行倾向评分匹配，创建一个匹配组，以比较 RO-ZES 与 SAMMPRIS 药物治疗和治疗组（SAMMPRIS 经皮血管成形术和支架置入术[S-PTAS]）之间的差异。
共 132 例患者符合纳入标准进行分析（平均年龄：64.2 岁）。狭窄程度平均为 81.4%（±11.4%）。RO-ZES 组治疗后 30 天内报告了 4 例（3.03%）中风和/或死亡，而 SAMMPRIS 药物治疗组为 6.6%（OR[比值比]2.26，95%CI0.7-9.56，P=0.22），S-PTAS 组为 15.6%（OR5.9，95%CI2.04-23.4，P<.001）。在每个组的 115 名患者中进行倾向评分匹配分析，RO-ZES 组 30 天内的中风和/或死亡率为 2.6%，S-PTAS 组为 15.6%（OR6.88，95%CI1.92-37.54，P<.001）。
与 S-PTAS 组相比，接受 RO-ZES 治疗的患者 30 天内的中风和/或死亡率相对较低。需要进一步进行大规模前瞻性研究，以评估 RO-ZES 治疗 sICAD 的安全性和有效性。
