Angioplasty and/or stenting after thrombectomy in patients with underlying intracranial atherosclerotic stenosis
Angioplasty and/or stenting after thrombectomy in patients with underlying intracranial atherosclerotic stenosis
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颅内动脉粥样硬化性狭窄患者血栓切除术后的血管成形术和/或支架置入术
DOI：
10.1007/s00234-019-02262-5
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发表时间：
2019-09-01
期刊：
影响因子：
2.8
通讯作者：
Ji, Xunming
中科院分区：
文献类型：
--
作者：
Wu, Chuanjie;Chang, Wansheng;Ji, Xunming
目的探讨急诊大血管闭塞（ELVO）合并颅内动脉粥样硬化性狭窄（ICAS）患者行急诊血管成形术和（或）支架植入术或不行支架植入术的影像学和临床结局。方法在这项多中心前瞻性队列研究中，我们纳入了伴有潜在ICAS的ELVO患者。根据介入医生的判断，患者在机械血栓切除术后接受紧急血管成形术和/或支架植入术或不接受。主要结局是24 h的再通率，其定义为改良动脉闭塞病变评分为2或3。结果113例前脑循环ICAS > 70%的患者入选本研究。其中，81例（71.7%）在血栓切除术后接受了紧急血管成形术和/或支架植入术。急诊血管成形术和/或支架植入术组患者在24 h时再通的可能性显著更高（校正OR [aOR]，3.782; 95%置信区间[CI]，1.821-9.125; P = 0.02），早期神经功能恶化的可能性更低（aOR，0.299; 95% CI，0.110-0.821; P = 0.01）。然而，急诊血管成形术和/或支架植入术与症状性颅内出血无显著相关性（aOR，0.710; 95% CI，0.199-2.622; P = 0.67），无症状性颅内出血（aOR，1.325; 95% CI，0.567-3.031; P = 0.81），90天时死亡（aOR，0.581; 95%CI，0.186-2.314; P = 0.41），90天时的功能独立性（aOR，1.752; 95%CI，0.774-3.257; P = 0.16）。结论ELVO合并ICAS的患者可以进行紧急血管成形术和/或支架植入术，并且可以降低再闭塞和早期神经功能恶化的风险，而颅内出血和死亡的风险不会比未接受任何治疗的患者增加。
Purpose To investigate the imaging and clinical outcomes of emergent angioplasty and/or stenting or neither in patients of emergent large-vessel occlusion (ELVO) with underlying severe intracranial atherosclerotic stenosis (ICAS). Methods In this multicenter prospective cohort study, we included patients of ELVO with underlying ICAS. Patients received emergent angioplasty and/or stenting or neither after mechanical thrombectomy at the interventionists' discretion. The primary outcome was recanalization rate at 24 h, which was defined as a modified arterial occlusive lesion score of 2 or 3. Results A total of 113 consecutive patients with underlying ICAS > 70% in anterior cerebral circulation were enrolled in this study. Of these, 81 (71.7%) received emergent angioplasty and/or stenting after thrombectomy. Patients in the emergent angioplasty and/or stenting group were significantly more likely to have recanalization at 24 h (adjusted OR [aOR], 3.782; 95% confidence interval [CI], 1.821-9.125; P = 0.02) and less likely to have early neurologic deterioration (aOR, 0.299; 95% CI, 0.110-0.821; P = 0.01). However, emergent angioplasty and/or stenting was not significantly associated with symptomatic intracranial hemorrhage (aOR, 0.710; 95% CI, 0.199-2.622; P = 0.67), asymptomatic intracranial hemorrhage (aOR, 1.325; 95% CI, 0.567-3.031; P = 0.81), death at 90 days (aOR, 0.581; 95% CI, 0.186-2.314; P = 0.41), and functional independence at 90 days (aOR, 1.752; 95% CI, 0.774-3.257; P = 0.16), compared with patients that received neither. Conclusion Emergent angioplasty and/or stenting is possible in patients of ELVO with ICAS and may reduce the risk of reocclusion and early neurologic deterioration with no increased risk of intracranial hemorrhage and death than those received neither.