采用机械血栓切除术治疗夹层相关串联闭塞症时,第 1 天颈动脉通畅对疗效的影响

IF 3 3区 医学 Q2 CLINICAL NEUROLOGY Journal of Neuroradiology Pub Date : 2024-02-01 DOI:10.1016/j.neurad.2024.01.076
Guillaume Perrin , Elisabeth Molinier , Benjamin Gory , Maeva Kyheng , Julien Labreuche , Marco Pasi , Kevin Janot , Romain Bourcier , Igor Sibon , Arturo Consoli , Jean-Philippe Desilles , Jean-Marc Olivot , Chrysanthi Papagiannaki , Sebastien Soize , Jean-Christophe Gentric , Cyril Dargazanli , Jildaz Caroff , Raoul Pop , Olivier Naggara , Solene Moulin , Gaultier Marnat
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引用次数: 0

摘要

背景:机械取栓术(MT)对串联闭塞的卒中患者的临床获益与孤立的颅内闭塞相似。然而,在机械取栓术中如何处理颈内动脉(ICA)闭塞,尤其是在颈动脉夹层的情况下,仍存在争议。我们旨在研究颈部颈内动脉(ICA)第1天的通畅对3个月功能预后的临床影响:我们从缺血性中风的血管内治疗中收集了数据,这是一项前瞻性的国家登记,在 2015 年 1 月至 2022 年 1 月期间,法国有 30 个中心开展了 MT 治疗。纳入标准为接受 MT 治疗的颈部 ICA 夹层相关的连续串联闭塞。其他病因引起的串联闭塞、无颅内血栓的孤立性颈部ICA闭塞以及未进行ICA第一天成像的患者不在纳入之列。主要终点是 3 个月的功能预后。次要终点包括颅内出血(ICH)、优良预后、死亡率和早期神经功能改善。对MT术后颅内再通有利的患者进行了敏感性分析:在研究期间,共纳入了 137 名患者,其中 89 人(65%)在第 1 天时出现了 ICA 通畅。第 1 天 ICA 通畅和闭塞患者的良好预后几率无明显差异(68.7 vs 59.1%;aOR=1.30;95%CI 0.56-3.00,p=0.54)。两组患者的优良预后、早期神经功能改善、死亡率和 ICH 也相当。敏感性分析显示了相似的结果:结论:对于因夹层导致串联闭塞的患者,第1天的ICA通畅率似乎并不影响功能预后。在这种情况下,可能不需要系统性地进行包括支架在内的颈部 ICA 血管内再通路治疗。
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Impact of Day 1 carotid patency on outcome in dissection-related tandem occlusions treated with mechanical thrombectomy

Background

The clinical benefit of mechanical thrombectomy(MT) for stroke patients with tandem occlusion is similar to that of isolated intracranial occlusions. However, the management of cervical internal carotid artery(ICA) occlusion during the MT, particularly in the setting of carotid dissection, remains controversial. We aimed to investigate the clinical impact of cervical ICA patency at day 1 on 3-month functional outcome.

Methods

We collected data from the Endovascular Treatment in Ischemic Stroke, a prospective national registry in 30 French centers performing MT between January 2015 and January 2022. Inclusion criteria were consecutive tandem occlusions related to cervical ICA dissection treated with MT. Tandem occlusions of other etiology, isolated cervical ICA occlusions without intracranial thrombus and patients without day-1 ICA imaging were excluded. Primary endpoint was the 3-month functional outcome. Secondary endpoints included intracranial hemorrhage(ICH), excellent outcome, mortality and early neurological improvement. A sensitivity analysis was performed in patients with intracranial favorable recanalization after MT.

Results

During the study period, 137 patients were included of which 89(65%) presented ICA patency at day 1. The odds of favorable outcome did not significantly differ between patients with patent and occluded ICA at day 1(68.7 vs 59.1%;aOR=1.30;95%CI 0.56-3.00,p=0.54). Excellent outcome, early neurological improvement, mortality and ICH were also comparable between groups. Sensitivity analysis showed similar results.

Conclusion

ICA patency at day 1 in patients with tandem occlusions related to dissection did not seem to influence functional outcome. Endovascular recanalization of the cervical ICA including stenting might not be systematically required in this setting.

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来源期刊
Journal of Neuroradiology
Journal of Neuroradiology 医学-核医学
CiteScore
6.10
自引率
5.70%
发文量
142
审稿时长
6-12 weeks
期刊介绍: The Journal of Neuroradiology is a peer-reviewed journal, publishing worldwide clinical and basic research in the field of diagnostic and Interventional neuroradiology, translational and molecular neuroimaging, and artificial intelligence in neuroradiology. The Journal of Neuroradiology considers for publication articles, reviews, technical notes and letters to the editors (correspondence section), provided that the methodology and scientific content are of high quality, and that the results will have substantial clinical impact and/or physiological importance.
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