Meyer Lukas, Broocks Gabriel, Alexandrou Maria, Lüttich Álex, Larrea José Ángel, Schwindt Wolfram, Krähling Hermann, Naziri Weis, Behme Daniel, Thormann Maximilian, Styczen Hanna, Deuschl Cornelius, Kabbasch Christoph, Zaeske Charlotte, Weyland Charlotte, Hernández Petzsche Moritz Roman, Maegerlein Christian, Zimmermann Hanna, Ernst Marielle, Jamous Ala, Moreu Gamazo Manuel, Pérez-García Carlos, Navia Pedro, Fernández Prieto Andrés, Yeo Leonard, Tan Benjamin, Gopinathan Anil, Siebert Eberhard, Miszczuk Milena, Schob Stefan, Sporns Peter, Zamarro Parra Joaquín, Parrilla Guillermo, Arnberg Fabian, Andersson Tommy, Zeleňák Kamil, Papanagiotou Panagiotis, Psychogios Marios, Möhlenbruch Markus, Kemmling André, Dorn Franziska, Elsharkawy Mohamed, Fiehler Jens, Stracke Christian Paul
From the Dept of Diagnostic and Interventional Neuroradiology, Univ Medical Ctr Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., G.B., P.S., J.F., C.P.S.); Dept of Diagnostic and Interventional Neuroradiology, Hosp Bremen-Mitte, Bremen, Germany (M.A., P.P.); Interventional Neuroradiology Section, Dept of Radiology, Donostia Univ Hosp, Donostia-San Sebastián, Spain (Á.L., J.Á.L.); Clinic for Radiology, Section for Interventional Radiology, Univ of Münster and Univ Hosp Münster, Münster, Germany (W.S., H.K., C.P.S.); Dept of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Dept of Neuroradiology, Otto-von-Guericke-Universitätsklinikum Magdeburg, Magdeburg, Germany (D.B., M.T.); Inst for Diagnostic and Interventional Radiology and Neuroradiology, Univ Hosp Essen, Essen, Germany (H.S., C.D.); Dept of Neuroradiology, Univ of Cologne, Cologne, Germany (C.K., C.Z.); Dept of Neuroradiology, Univ Hosp Aachen, Aachen, Germany (C.W., M. Möhlenbruch); Dept of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical Univ Munich, Munich, Germany (M.R.H.P., C.M.); Inst of Neuroradiology, Univ Hosps, LMU Munich, Munich, Germany (H.Z.); Dept of Diagnostic and Interventional Neuroradiology, Univ Medical Ctr Goettingen, Goettingen, Germany (M. Ernst, A.J.); Interventional Neuroradiology, Dept of Radiology, Hosp Clínico San Carlos, Madrid, Spain (M.M.G., C.P.G.); Dept of Neuroradiology, Hosp Universitario La Paz, Madrid, Spain (P.N., A.F.P.); Div of Neurology, Dept of Medicine (L.Y., B.T.), and Div of Interventional Radiology, Dept of Diagnostic Imaging (A.G.), National Univ Health System, Singapore; Yong Loo Lin School of Medicine, National Univ of Singapore, Singapore (L.Y., B.T., A.G.); Inst of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (E.S., M. Miszczuk); Dept of Neuroradiology, Clinic and Policlinic of Radiology, Univ Hosp Halle/Saale, Halle, Germany (S.S.); Dept of Radiology and Neuroradiology, Stadtspital Zürich, Zürich, Switzerland (P.S.); Dept of Diagnostic and Interventional Neuroradiology, Univ Hosp Basel, Basel, Switzerland (P.S., M.P.); Depts of Interventional Neuroradiology (J.Z.P.) and Neurology (G.P.), Hosp Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; Dept of Neuroradiology, Karolinska Univ Hosp and Dept of Clinical Neuroscience, Karolinska Inst, Stockholm, Sweden (F.A., T.A.); Dept of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Dept of Radiology, Comenius Univ's Jessenius Faculty of Medicine and Univ Hosp, Martin, Slovakia (K.Z.); Dept of Radiology, Aretaieion Univ Hosp, National and Kapodistrian Univ of Athens, Athens, Greece (P.P.); Dept of Neuroradiology, Univ Hosp Marburg, Marburg, Germany (A.K.); Dept of Neuroradiology, Univ Hosp of Bonn, Bonn, Germany (F.D.); and Dept of Neuroradiology, Alfried Krupp Krankenhaus, Essen, Germany (M. Elsharkawy).
Radiology. 2025 Jan;314(1):e240293. doi: 10.1148/radiol.240293.
Background Symptomatic acute occlusions of the internal carotid artery (ICA) below the circle of Willis can cause a variety of stroke symptoms, even if the major intracranial cerebral arteries remain patent; however, outcome and safety data are limited. Purpose To compare treatment effects and procedural safety of endovascular treatment (EVT) and best medical treatment (BMT) in patients with symptomatic acute occlusions of the ICA below the circle of Willis. Materials and Methods This retrospective, multicenter cohort study from 22 comprehensive stroke centers in Europe and Asia includes patients treated between January 1, 2008, and December 31, 2022. Functional (modified Rankin Scale [mRS]) and clinical (National Institutes of Health Stroke Scale [NIHSS]) outcomes, safety measures (symptomatic intracerebral hemorrhage), mortality, and procedural complications were assessed. Results A total 354 patients met the inclusion criteria (median age, 72 years [IQR, 60-81 years]; median NIHSS, 13 [IQR, 7-19]). Most frequent occlusions were in the C1 segment (243 of 354; 68.6%). Of 354 patients, 82.2% (291 patients) were administered EVT. In the overall population, favorable outcomes (mRS 0-2), mortality, and symptomatic intracerebral hemorrhage occurred in 40.6% (108 of 266 patients), 25.2% (67 of 266 patients), and 7.1% (25 of 350 patients), respectively. After adjustment, no statistically significant difference in functional outcome was observed (adjusted odds ratio [AOR], 0.82 [95% CI: 0.31, 2.12]; average treatment effect, -12.7%; = .19) in the EVT compared with BMT group. Symptomatic intracerebral hemorrhage (average treatment effect, -0.28%; = .95) and mortality did not differ between both groups (average treatment effect, -17.1%; = .07). EVT resulted in complete recanalization of the occlusion in 80.9% (229 of 283) of cases. Periprocedural distal embolization occurred in 27.8% (81 of 291 patients) and was associated with poor outcomes (AOR, 0.41; 95% CI: 0.18, 0.93; = .03). Conclusion EVT did not reveal a favorable treatment effect over BMT, and both therapies were safe. EVT had a risk for periprocedural distal embolization associated with poor outcomes. © RSNA, 2025 See also the editorial by Daou and Chaudhary in this issue.
Willis 环以下的颈内动脉（ICA）出现症状性急性闭塞，即便主要的颅内脑动脉仍保持通畅，也可引发多种中风症状；然而，相关的预后和安全性数据有限。目的：比较血管内治疗（EVT）和最佳药物治疗（BMT）对 Willis 环以下 ICA 症状性急性闭塞患者的治疗效果和手术安全性。材料与方法：这项回顾性、多中心队列研究来自欧洲和亚洲的 22 个综合卒中中心，纳入了 2008 年 1 月 1 日至 2022 年 12 月 31 日期间接受治疗的患者。评估了功能（改良 Rankin 量表[mRS]）和临床（美国国立卫生研究院卒中量表[NIHSS]）结局、安全指标（症状性脑出血）、死亡率和手术并发症。结果：共有 354 例患者符合纳入标准（中位年龄 72 岁[四分位间距，60 - 81 岁]；中位 NIHSS 为 13[四分位间距，7 - 19]）。最常见的闭塞部位是 C1 段（354 例中的 243 例；68.6%）。354 例患者中，82.2%（291 例患者）接受了 EVT。在总体人群中，良好结局（mRS 0 - 2）、死亡率和症状性脑出血的发生率分别为 40.6%（266 例患者中的 108 例）、25.2%（266 例患者中的 67 例）和 7.1%（350 例患者中的 25 例）。调整后，与 BMT 组相比，EVT 组在功能结局方面未观察到统计学上的显著差异（调整后的优势比[AOR]，0.82[95%置信区间：0.31，2.12]；平均治疗效果，-12.7%；P = 0.19）。两组在症状性脑出血（平均治疗效果，-0.28%；P = 0.95）和死亡率方面无差异（平均治疗效果，-17.1%；P = 0.07）。EVT 在 80.9%（283 例中的 229 例）的病例中实现了闭塞的完全再通。围手术期远端栓塞发生在 27.8%（291 例患者中的 81 例），且与不良结局相关（AOR，- 0.41；95%置信区间：0.18，0.93；P = 0.03）。结论：与 BMT 相比，EVT 未显示出更好的治疗效果，且两种治疗方法均安全。EVT 存在围手术期远端栓塞风险，与不良结局相关。©RSNA，2025 另见本期 Daou 和 Chaudhary 的社论。
