Department of Neurosurgery, Teine Keijinkai Hospital, Maeda 1-12-1-40, Teine-ku, Sapporo, Hokkaido 006-8111, Japan.
Department of Cerebrovascular Medicine, Teine Keijinkai Hospital, Maeda 1-12-1-40, Teine-ku, Sapporo, Hokkaido 006-8111, Japan.
Clin Neurol Neurosurg. 2023 May;228:107680. doi: 10.1016/j.clineuro.2023.107680. Epub 2023 Mar 16.
Clinical characteristics of endovascular treatment (EVT) for acute ischemic stroke (AIS) secondary to atherosclerosis are not fully delineated. An optimal treatment strategy with considerations of stroke etiology has not yet been established. Here-in, we performed retrospective analysis of EVT for atherosclerotic AIS.
Data from patients with AIS who underwent EVT between 2017 and 2022 were analyzed. Clinical characteristics, procedural data, and outcomes were assessed. Further analysis was conducted to elucidate the factors associated with clinical outcomes. And data of patients with poor clinical outcomes (mRS, 5 or 6) were evaluated further to determine the primary cause.
Among 194 patients who received EVT, 40 (20.6%) were diagnosed with AIS with an atherosclerotic etiology. The rates of successful reperfusion (TICI 2b or 3) and good clinical outcomes (mRS, 0-2) were 95.0% and 45.0%, respectively. No procedure-related complications were noted. Older age (p = 0.007), more severe baseline NIHSS score (p = 0.004), lesion in the posterior circulation (p = 0.025), and recanalization failure (p = 0.027) were more frequently observed in patients with poor clinical outcomes. Brainstem infarction and postprocedural intracerebral hemorrhage were the main reasons for poor clinical outcomes.
The EVT for atherosclerotic AIS were effective and safe. Older age, more severe NIHSS score, lesions in the posterior circulation, and recanalization failure were the factors associated with poor clinical outcomes. It is important to recognize that these factors may aggravate the clinical response to this promising therapy, even in patient successful recanalization was attained.
动脉粥样硬化性急性缺血性脑卒中（AIS）的血管内治疗（EVT）的临床特征尚未完全阐明。尚未建立考虑中风病因的最佳治疗策略。在此，我们对动脉粥样硬化性 AIS 的 EVT 进行回顾性分析。
分析了 2017 年至 2022 年期间接受 EVT 的 AIS 患者的数据。评估了临床特征、程序数据和结局。进一步分析了与临床结局相关的因素。并进一步评估了预后不良（mRS，5 或 6）患者的数据，以确定主要原因。
在 194 名接受 EVT 的患者中，40 名（20.6%）被诊断为动脉粥样硬化性病因的 AIS。成功再灌注（TICI 2b 或 3）和良好临床结局（mRS，0-2）的比例分别为 95.0%和 45.0%。没有观察到与程序相关的并发症。年龄较大（p=0.007）、基线 NIHSS 评分较高（p=0.004）、后循环病变（p=0.025）和再通失败（p=0.027）的患者更常出现不良临床结局。脑干梗死和术后颅内出血是预后不良的主要原因。
EVT 治疗动脉粥样硬化性 AIS 是有效且安全的。年龄较大、NIHSS 评分较高、后循环病变和再通失败是与不良临床结局相关的因素。重要的是要认识到，即使患者成功再通，这些因素也可能加重对这种有前途的治疗的临床反应。
