Li Zifu, Chen Rundong, Hua Weilong, Zhang Hongjian, Shen Hongjian, Xing Pengfei, Zhang Lei, Zhang Yongwei, Yang Pengfei, Liu Jianmin
Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China.
Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China; School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China.
J Clin Neurosci. 2025 Sep;139:111459. doi: 10.1016/j.jocn.2025.111459. Epub 2025 Jul 11.
Intracranial large vessel occlusion due to atherosclerotic stenosis (ICAS) complicates acute ischemic stroke (AIS) management, with challenges such as reocclusion, thrombus migration. This study provides a preliminary evaluation of a novel technique-Facilitating Angioplasty and Stenting with a Dual-Lumen Balloon Microcatheter-for ICAS-related large vessel occlusions, using data from a single-center registry and comparing them to a reference cohort from a multicenter trial.
This retrospective study utilized data from two sources: the OCEAN-AIS-EVT REGISTRY for the FAST ICAS group and the DIRECT-MT trial for the traditional treatment group. A total of 60 patients were included, with 17 patients in the FAST ICAS group and 43 in the traditional group. Although group comparisons are presented, the differing data sources and limited sample size warrant caution. Clinical and procedural outcomes were examined, focusing on time from puncture to reperfusion, eTICI scores, and 90-day functional outcomes.
The FAST ICAS group demonstrated a shorter median time from puncture to reperfusion (38 min vs. 62 min, p = 0.023) and a higher rate of eTICI 3 scores (82.4 % vs. 34.9 %, p = 0.006). Although a greater proportion of patients in the FAST ICAS group achieved excellent functional outcomes (mRS ≤ 1) compared to the traditional group (47.1 % vs. 34.9 %), this difference was not statistically significant (p = 0.562). Two patients in the FAST ICAS group required conversion to traditional methods due to severe vascular tortuosity.
FAST ICAS may offer improved procedural efficiency and angiographic results in ICAS-related AIS, potentially achieving faster reperfusion and higher eTICI 3 rates. However, these findings are exploratory, and further large-scale, multicenter trials are essential to validate the efficacy of FAST ICAS, optimize its application, and assess its long-term benefits across diverse patient populations..
动脉粥样硬化性狭窄所致颅内大血管闭塞（ICAS）使急性缺血性卒中（AIS）的治疗变得复杂，存在再闭塞、血栓迁移等挑战。本研究使用单中心注册数据并与多中心试验的参考队列进行比较，对一种新技术——双腔球囊微导管辅助血管成形术和支架置入术——用于与ICAS相关的大血管闭塞进行了初步评估。
这项回顾性研究利用了两个来源的数据：FAST ICAS组的数据来自OCEAN - AIS - EVT注册研究，传统治疗组的数据来自DIRECT - MT试验。共纳入60例患者，其中FAST ICAS组17例，传统组43例。尽管进行了组间比较，但不同的数据来源和有限的样本量需谨慎对待。检查了临床和手术结果，重点关注从穿刺到再灌注的时间、脑梗死溶栓分级（eTICI）评分以及90天功能结果。
FAST ICAS组从穿刺到再灌注的中位时间较短（38分钟对62分钟，p = 0.023），eTICI 3级评分的比例较高（82.4%对34.9%，p = 0.006）。尽管与传统组相比，FAST ICAS组中有更大比例的患者获得了良好的功能结果（改良Rankin量表评分≤1）（47.1%对34.9%），但这种差异无统计学意义（p = 0.562）。FAST ICAS组中有2例患者因严重血管迂曲需要转换为传统方法。
FAST ICAS在与ICAS相关的AIS中可能提供更高的手术效率和血管造影结果，有可能实现更快的再灌注和更高的eTICI 3级率。然而，这些发现是探索性的，进一步的大规模、多中心试验对于验证FAST ICAS的疗效、优化其应用以及评估其在不同患者群体中的长期益处至关重要。
