Alexandre Andrea M, Scarcia Luca, Consoli Arturo, Sun Wen, Xu Yingjie, Huang Xianjun, Chung Charlotte, Sgreccia Alessandro, Abdalkader Mohamad, Limbucci Nicola, Pedicelli Alessandro, De Leoni Davide, Ganimede Maria P, Gaudino Chiara, Russo Riccardo, Papagiannaki Chrysanthi, Partesano Roberta, Mandruzzato Nicolò, Gabrieli Joseph D, Panni Pietro, Zini Andrea, Clarençon Frédéric, Raz Eytan, Nguyen Thanh N, Broccolini Aldobrando
From the Interventional Neuroradiology Unit (A.M.A., A.P.) and Neurology Unit (A.B.), Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome Italy; Department of Neuroradiology (L.S.), Henri Mondor Hospital, Creteil, France; Department of Diagnostic and Therapeutic Neuroradiology (A.C., A.S.), Hôpital Foch, Suresnes, France; Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, (W.S., Y.H), The First Affiliated Hospital of USTC, Hefei, Anhui, China; Department of Neurology (X.H.), Yijishan Hospital, Wannan Medical College, Wuhu, Anhui, China; Department of Neurosurgery and Department of Radiology (C.C., E.R.), NYU Langone Health, New York, NY, USA; Department of Radiology and Neurology (M.A., T.N.N.), Boston Medical Center, Boston, MA, USA; Interventional Neurovascular Unit (N.L.), A.O.U. Careggi, Firenze, Italy; Neuroradiology Unit (D.D.L.), ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Neuroradiology Unit (M.P.G.), Presidio Ospedaliero Centrale SS Annunziata, Taranto, Italy; Department of Neuroradiology (C.G.), Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy; Neuroradiology Unit (R.R.), Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy; Department of Radiology (C.P.), Rouen University Hospital, Rouen, France; Neuroradiology Unit (R.P.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Interventional Neuroradiology (N.M.), Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy; Neuroradiology Unit (J.D.G.), Padua University Hospital, Padua, Italy; Interventional Neuroradiology Unit (P.P.), IRCCS San Raffaele University Hospital, Milan, Italy; Department of Neurology and Stroke Center (A.Z.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy; Department of Interventional Neuroradiology (F.C.), Pitié-Salpêtrière University Hospital, Paris, France; Department of Neuroscience (A.B.), Catholic University School of Medicine, Rome, Italy.
AJNR Am J Neuroradiol. 2025 Jul 10. doi: 10.3174/ajnr.A8918.
In patients with acute large vessel occlusion (LVO) of the MCA and underlying intracranial artery stenosis (ICAS), rescue stenting (RS) has been associated with better angiographic outcomes and higher rates of functional independence compared to mechanical thrombectomy (MT) alone. However, uncertainty exists regarding safety of RS in patients at higher risk for intracranial bleeding.The primary aim of this retrospective multicenter study was to compare safety outcomes between patients with acute ICAS-LVO of the MCA who underwent MT and RS with or without prior intravenous thrombolysis (IVT). Efficacy outcomes were assessed as a secondary aim.
We screened the prospective databases of 26 stroke centers across Europe, the United States, and China for consecutive patients with acute MCA ICAS-LVO who received RS. Patients were divided into two groups based on prior administration of IVT: IVT/RS and no-IVT/RS. Propensity score matching (PSM), based on a set of covariates that also included peri-procedural antiplatelet therapies, was used to estimate the effect of IVT treatment. Primary safety outcomes were the occurrence of symptomatic intracranial hemorrhage (sICH) and 90-day mortality.
After PSM, 52 pairs of patients were available for analysis. No significant differences were observed between the two groups regarding rates of sICH (11.5% in IVT/RS group vs. 9.6% in no-IVT/RS group, OR 1.2, 95% CI 0.4-4.3, p = 0.75) and 90-day mortality (14.3% in the IVT/RS group vs. 11.7% in the no-IVT/RS group, OR 1.3, 95% CI 0.4-4.2, p = 0.71). There were also no significant differences in the occurrence of parenchymal hemorrhage types 1 and 2, successful recanalization rates and 90-day functional outcome.
The safety of RS in ICAS-LVO is not significantly affected by prior IVT administration. Furthermore, IVT does not result in improved recanalization and clinical outcome. These findings should be interpreted with caution and require validation through future randomized controlled studies.
MT＝ mechanical thrombectomy; LVO＝ large vessel occlusion; ICAS = intracranial artery stenosis; RS = rescue stenting; IVT = intravenous thrombolysis; sICH = symptomatic intracranial Hemorrhage; PH = parenchymal hematoma; SD = standard deviation; IQR = interquartile range; PSM = propensity score matching; SMD = standardized mean difference; OTG = onset-to-groin; GPI = glycoprotein IIb/IIIa inhibitors.
在大脑中动脉急性大血管闭塞（LVO）且合并颅内动脉狭窄（ICAS）的患者中，与单纯机械取栓术（MT）相比，补救性支架置入术（RS）已被证明具有更好的血管造影结果和更高的功能独立率。然而，颅内出血风险较高的患者接受RS的安全性仍存在不确定性。本项回顾性多中心研究的主要目的是比较接受MT和RS治疗（无论是否接受过静脉溶栓治疗[IVT]）的大脑中动脉急性ICAS-LVO患者的安全性结果。疗效结果作为次要目的进行评估。
我们筛选了欧洲、美国和中国26个卒中中心的前瞻性数据库，纳入连续接受RS治疗的急性大脑中动脉ICAS-LVO患者。根据是否接受过IVT将患者分为两组：IVT/RS组和未接受IVT/RS组。基于一组协变量（包括围手术期抗血小板治疗）进行倾向评分匹配（PSM），以评估IVT治疗的效果。主要安全性结果是症状性颅内出血（sICH）的发生情况和90天死亡率。
PSM后，共有52对患者可供分析。两组之间在sICH发生率（IVT/RS组为11.5%，未接受IVT/RS组为9.6%，OR 1.2，95%CI 0.4-4.3，p = 0.75）和90天死亡率（IVT/RS组为14.3%，未接受IVT/RS组为11.7%，OR 1.3，95%CI 0.4-4.2，p = 0.71）方面均无显著差异（1型和2型实质出血的发生率、成功再通率和90天功能结局也无显著差异）。
既往IVT治疗对ICAS-LVO患者接受RS的安全性无显著影响。此外，IVT并不能改善再通情况和临床结局。这些发现应谨慎解读，需要通过未来的随机对照研究进行验证。
MT＝机械取栓术；LVO＝大血管闭塞；ICAS =颅内动脉狭窄；RS =补救性支架置入术；IVT =静脉溶栓；sICH =症状性颅内出血；PH =实质血肿；SD =标准差；IQR =四分位数间距；PSM =倾向评分匹配；SMD =标准化均数差；OTG =发病至股动脉穿刺时间；GPI =糖蛋白IIb/IIIa抑制剂
