Chi Cuong T, Minh Thang L, Baxter Blaise, Nguyen Luu Giang, Ngo Minh Tuan, Nguyen Dao Nhat Huy, Minh Luan T, Duong Hoang Linh, Mai Van Muong
Can Tho Stroke International Services General Hospital (S.I.S Can Tho), Can Tho, Vietnam.
Lehigh Valley Health Network, Allentown, PA, USA.
Interv Neuroradiol. 2025 Jun;31(3):298-307. doi: 10.1177/15910199231171272. Epub 2023 Jul 6.
Background and PurposeIn cases of acute ischemic stroke that are caused by intracranial large vessel occlusion, rescue intracranial stenting has recently become a treatment option to achieve recanalization in patients when mechanical thrombectomy fails. However, there have been few studies to date that support this beneficial treatment. Our goal is to analyze whether the use of rescue intracranial stenting would improve "non-poor" prognosis in patients 3 months posttreatment.MethodsThis was a retrospective analysis of a prospective cohort of patients with acute ischemic stroke who were treated with rescue stenting at our hospital. Inclusion criteria for the study consisted of evidence of intracranial large vessel occlusion, absence of intracranial hemorrhage, and severe stenosis or reocclusion after mechanical thrombectomy. Tandem occlusions, failure to follow up after discharge, and a severe combined illness concomitant with acute ischemic stroke were excluded. The primary outcome was the "non-poor" outcome rate at 3 months and postprocedural symptomatic intracerebral hemorrhage.ResultsThe posttreatment outcomes of 85 eligible patients who received rescue intracranial stenting between August 2019 and May 2021 are reported. In total, 82 of these patients (96.5%) had successful recanalization and 4 (4.7%) experienced symptomatic intracerebral hemorrhage. In total, 47 (55.3%) patients had "non-poor" and 35 (41.2%) good outcomes at 3 months after treatment with rescue intracranial stenting. The use of dual antiplatelet therapy was associated with new infarcts (relative risk = 0.1; 95% confidence interval 0.01-0.7) and symptomatic intracerebral hemorrhage (relative risk = 0.1; 95% confidence interval 0.01-0.9).ConclusionOur study suggests that despite the occurrence of postprocedural symptomatic intracerebral hemorrhage in a low proportion of cases, rescue intracranial stenting could be an important alternative treatment after mechanical thrombectomy failure.
背景与目的
在由颅内大血管闭塞引起的急性缺血性卒中病例中，当机械取栓失败时，挽救性颅内支架置入术最近已成为实现患者血管再通的一种治疗选择。然而，迄今为止，支持这种有益治疗的研究很少。我们的目标是分析挽救性颅内支架置入术的使用是否会改善治疗后3个月患者的“非不良”预后。
方法
这是一项对在我院接受挽救性支架置入术的急性缺血性卒中患者前瞻性队列的回顾性分析。该研究的纳入标准包括颅内大血管闭塞的证据、无颅内出血以及机械取栓后严重狭窄或再闭塞。串联闭塞、出院后未随访以及与急性缺血性卒中同时存在的严重合并症被排除。主要结局是3个月时的“非不良”结局率和术后症状性脑出血。
结果
报告了2019年8月至2021年5月期间85例接受挽救性颅内支架置入术的符合条件患者的治疗后结局。这些患者中，共有82例（96.5%）成功实现血管再通，4例（4.7%）发生症状性脑出血。在接受挽救性颅内支架置入术治疗3个月后，共有47例（55.3%）患者有“非不良”结局，35例（41.2%）患者预后良好。双联抗血小板治疗的使用与新发梗死（相对风险=0.1；95%置信区间0.01 - 0.7）和症状性脑出血（相对风险=0.1；95%置信区间0.01 - 0.9）相关。
结论
我们的研究表明，尽管术后症状性脑出血的发生率较低，但挽救性颅内支架置入术可能是机械取栓失败后的一种重要替代治疗方法。
