Yu Shuai, Dong Xiao-Feng, Guo Zhi-Liang, Huang Zhi-Chao, Xu Peng-Fei, Tao Chun-Rong, Li Rui, Hu Wei, Xiao Guo-Dong
Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China.
EuroIntervention. 2024 Dec 2;20(23):e1476-e1483. doi: 10.4244/EIJ-D-24-00300.
Mechanical thrombectomy is the most effective treatment for restoring reperfusion in large vessel occlusion acute ischaemic stroke, even in patients with posterior circulation. However, the strategy for optimal treatment of patients with acute basilar artery occlusion (BAO) in difficult-to-treat cases in which thrombectomy has failed is unknown.
The purpose of this study was to evaluate the clinical efficacy and safety of rescue intracranial stenting (RIS) in patients with acute BAO treated with thrombectomy.
Stroke patients with acute BAO who had undergone failed mechanical thrombectomy in the ATTENTION registry were enrolled in this study. Univariable and multivariable regression analyses were performed to assess the clinical efficacy and safety of RIS.
A total of 477 patients were included in the analysis, and 346 patients underwent RIS, of whom 167 (35.0%) patients had a favourable outcome. Symptomatic intracranial haemorrhage (sICH) occurred in 24 (5.0%) patients, and 172 (36.1%) patients died. There were no significant differences between the two groups of patients in the outcomes of modified Rankin Scale (mRS) 0-1 (p=0.541), mRS 0-2 (p=0.374), mRS 0-3 (p=0.600), or death (p=0.706). Patients in the RIS+ group had a significantly higher incidence of sICH (1.5% vs 6.4%; p=0.031). Nevertheless, after adjusting for confounders, RIS was not found to be an independent risk factor for sICH (adjusted odds ratio 4.189, 95% confidence interval: 0.960-18.286; p=0.057).
In this national, multicentre, prospective study, RIS in patients with acute BAO who had undergone failed first-line thrombectomy was feasible, but we could not show significance regarding improved long-term outcomes.
ChiCTR2000041117.
机械取栓术是恢复大血管闭塞急性缺血性卒中再灌注的最有效治疗方法，即使是在后循环患者中。然而，在取栓失败的难治性病例中，急性基底动脉闭塞（BAO）患者的最佳治疗策略尚不清楚。
本研究旨在评估挽救性颅内支架置入术（RIS）在接受取栓治疗的急性BAO患者中的临床疗效和安全性。
将在ATTENTION注册研究中接受机械取栓失败的急性BAO卒中患者纳入本研究。进行单变量和多变量回归分析以评估RIS的临床疗效和安全性。
共有477例患者纳入分析，346例患者接受了RIS，其中167例（35.0%）患者预后良好。24例（5.0%）患者发生有症状性颅内出血（sICH），172例（36.1%）患者死亡。两组患者在改良Rankin量表（mRS）0-1（p=0.541）、mRS 0-2（p=0.374）、mRS 0-3（p=0.600）或死亡（p=0.706）结局方面无显著差异。RIS+组患者的sICH发生率显著更高（1.5%对6.4%；p=0.031）。然而，在调整混杂因素后，未发现RIS是sICH的独立危险因素（调整后的优势比4.189，95%置信区间：0.960-18.286；p=0.057）。
在这项全国性、多中心、前瞻性研究中，一线取栓失败的急性BAO患者行RIS是可行的，但我们未能证明其在改善长期结局方面具有显著意义。
ChiCTR2000041117。
