Riegler Christoph, von Rennenberg Regina, Bollweg Kerstin, Siebert Eberhard, de Marchis Gian Marco, Kägi Georg, Mordasini Pasquale, Heldner Mirjam R, Magoni Mauro, Pezzini Alessandro, Salerno Alexander, Michel Patrik, Globas Christoph, Wegener Susanne, Martinez-Majander Nicolas, Curtze Sami, Dell'Acqua Maria Luisa, Bigliardi Guido, Wali Nabila, Nederkoorn Paul J, Jovanovic Dejana R, Padjen Visnja, Metanis Issa, Leker Ronen R, Bianco Giovanni, Cereda Carlo W, Pascarella Rosario, Zedde Marialuisa, Viola Maria Maddalena, Zini Andrea, Ramos João Nuno, Marto João Pedro, Audebert Heinrich J, Trüssel Simon, Gensicke Henrik, Engelter Stefan T, Nolte Christian H
Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Bern, Germany.
Eur Stroke J. 2025 Jun;10(2):406-415. doi: 10.1177/23969873241278948. Epub 2024 Oct 29.
Acute intracranial occlusion of the internal carotid artery (ICA) can be distinguished into (a) occlusion of the terminal ICA, involving the proximal segments of the middle or anterior cerebral artery (ICA-L/-T) and (b) non-terminal intracranial occlusions of the ICA with patent circle of Willis (ICA-I). While patients with ICA-L/-T occlusion were included in all randomized controlled trials on endovascular therapy (EVT) in anterior large vessel occlusion, data on EVT in ICA-I occlusion is scarce. We thus aimed to evaluate effectiveness and safety of EVT in ICA-I occlusions in comparison to ICA-L/-T occlusions.
A large international multicentre cohort was searched for patients with intracranial ICA occlusion treated with EVT between 2014 and 2023. Patients were stratified by ICA occlusion pattern, differentiating ICA-I and ICA-L/-T occlusions. Baseline factors, technical (modified thrombolysis in cerebral infarction (mTICI) scale) and functional outcomes (modified Rankin scale [mRS] at 3 months) as well as rates of (symptomatic) intracranial hemorrhage ([s]ICH) were analyzed.
Of 13,453 patients, 1825 (13.6%) had isolated ICA occlusion. ICA-occlusion pattern was ICA-I in 559 (4.2%) and ICA-L/-T in 1266 (9.4%) patients. Age (years: 74 vs 73), sex (female: 45.8% vs 49.0%) and pre-stroke functional independency (pre-mRS ⩽ 2: 89.9% vs 92.2%) did not differ between the groups. Stroke severity was lower in ICA-I patients (NIHSS at admission: 14 [7-19] vs 17 [13-21] points). EVT was similarly successful with respect to technical (mTICI2b/3: 76.1% (ICA-I) vs 76.6% (ICA-L/-T); aOR 1.01 [0.76-1.35]) and functional outcome (mRS ordinal shift cOR 1.01 [0.83-1.23] in adjusted analyses. Rates of ICH (18.9% vs 34.5%; aOR 0.47 [0.36-0.62] and sICH (4.7% vs 7.3%; aOR 0.58 [0.35-0.97] were lower in ICA-I patients.
EVT might be performed safely and similarly successful in patients with ICA-I occlusions as in patients with ICA-L/-T occlusions.
颈内动脉（ICA）急性颅内闭塞可分为：（a）颈内动脉终末段闭塞，累及大脑中动脉或大脑前动脉近端（ICA-L/-T）；（b）Willis环通畅的颈内动脉非终末段颅内闭塞（ICA-I）。虽然所有关于前循环大血管闭塞血管内治疗（EVT）的随机对照试验均纳入了ICA-L/-T闭塞患者，但关于ICA-I闭塞患者接受EVT的数据却很少。因此，我们旨在评估与ICA-L/-T闭塞相比，EVT治疗ICA-I闭塞的有效性和安全性。
检索一个大型国际多中心队列，以寻找2014年至2023年间接受EVT治疗的颅内ICA闭塞患者。患者根据ICA闭塞模式进行分层，区分ICA-I和ICA-L/-T闭塞。分析基线因素、技术指标（改良脑梗死溶栓（mTICI）量表）和功能结局（3个月时的改良Rankin量表[mRS]）以及（有症状）颅内出血（[s]ICH）发生率。
在13453例患者中，1825例（13.6%）存在孤立性ICA闭塞。559例（4.2%）患者的ICA闭塞模式为ICA-I，1266例（9.4%）患者为ICA-L/-T。两组间年龄（岁：74对73）、性别（女性：45.8%对49.0%）和卒中前功能独立性（mRS≤2：89.9%对92.2%）无差异。ICA-I患者的卒中严重程度较低（入院时NIHSS评分：14[7-19]分对17[13-21]分）。在技术指标（mTICI 2b/3：76.1%（ICA-I）对76.6%（ICA-L/-T）；调整后比值比1.01[0.76-1.35]）和功能结局（调整分析中mRS序数移位校正比值比1.01[0.83-1.23]）方面，EVT同样成功。ICA-I患者的ICH发生率（18.9%对34.5%；调整后比值比0.47[0.36-0.62]）和sICH发生率（4.7%对7.3%；调整后比值比0.58[0.35-0.97]）较低。
ICA-I闭塞患者接受EVT可能与ICA-L/-T闭塞患者一样安全且同样成功。
