Emergency Stenting of the Extracranial Internal Carotid Artery in Combination with Anterior Circulation Thrombectomy in Acute lschemic Stroke: A Retrospective Multicenter Study
Emergency Stenting of the Extracranial Internal Carotid Artery in Combination with Anterior Circulation Thrombectomy in Acute lschemic Stroke: A Retrospective Multicenter Study
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DOI：
10.3174/ajnr.a4459
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发表时间：
2015-12-01
影响因子：
3.5
通讯作者：
Weber, W.
中科院分区：
文献类型：
--
作者：
Behme, D.;Mpotsaris, A.;Weber, W.
背景和目的：几个小型病例系列报告了在急性卒中中颅外颈内动脉紧急支架植入联合机械血栓切除术的有利临床结局。据报告，介入后症状性颅内血肿的发生率高达20%。因此，我们调查了这项技术的安全性和有效性在一个大型的多中心coherent.MATERIALS和METHODS：4个德国中风中心的数据库进行了筛选的所有患者接受紧急支架置入术的颅外颈内动脉与机械血栓切除术的前循环在2007年和2014年之间。主要结局指标是根据欧洲急性卒中研究III标准的症状性颅内出血的发生率;次要结局指标包括血管造影血运重建结果和临床outcome.RESULTS：170例中位年龄为64岁（范围25-88岁）的患者接受了治疗。他们在中位98分钟（范围，52-160分钟）后出现，中位NIHSS评分为15（范围，12-19）。15/170例（9%）患者发生症状性颅内血管闭塞;年龄、性别、静脉rtPA、手术时间和成功再通率方面，各组间无统计学显著差异。130/170例（77%）患者的TICI评分>= 2b。在医院的死亡率为19%，36%的患者有一个良好的结果在follow-up.CONCLUSIONS：紧急支架置入在颅外颈内动脉结合前循环血栓切除术是有效和安全的。与单独机械血栓切除术的已发表系列相比，其与症状性颅内出血风险显著升高无关。
BACKGROUND AND PURPOSE: Several small case series reported a favorable clinical outcome for emergency stent placement in the extracranial internal carotid artery combined with mechanical thrombectomy in acute stroke. The rate of postinterventional symptomatic intracranial hemorrhages was reported to be as high as 20%. Therefore, we investigated the safety and efficacy of this technique in a large multicentric cohort.MATERIALS AND METHODS: The data bases of 4 German stroke centers were screened for all patients who received emergency stent placement of the extracranial internal carotid artery in combination with mechanical thrombectomy of the anterior circulation between 2007 and 2014. The primary outcome measure was the rate of symptomatic intracranial hemorrhage according to the European Cooperative Acute Stroke Study III criteria; secondary outcome measures included the angiographic revascularization results and clinical outcome.RESULTS: One hundred seventy patients with a median age of 64 years (range, 25-88 years) were treated. They presented after a median of 98 minutes (range, 52-160 minutes) with a median NIHSS score of 15 (range, 12-19). Symptomatic intracranial hemorrhages occurred in 15/170 (9%) patients; there was no statistically significant difference among groups pertaining to age, sex, intravenous rtPA, procedural timings, and the rate of successful recanalization. In 130/170(77%) patients, a TICI score of >= 2b could be achieved. The in-hospital mortality rate was 19%, and 36% of patients had a favorable outcome at follow-up.CONCLUSIONS: Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is effective and safe. It is not associated with a significantly higher risk of symptomatic intracranial hemorrhage compared with published series for mechanical thrombectomy alone.