急性颅内非终末颈内动脉闭塞（ICA-I）患者的血管内治疗。

IF 5.8 3区医学 Q1 CLINICAL NEUROLOGY European Stroke Journal Pub Date : 2024-10-29 DOI:10.1177/23969873241278948

Christoph Riegler, Regina von Rennenberg, Kerstin Bollweg, Eberhard Siebert, Gian Marco de Marchis, Georg Kägi, Pasquale Mordasini, Mirjam R Heldner, Mauro Magoni, Alessandro Pezzini, Alexander Salerno, Patrik Michel, Christoph Globas, Susanne Wegener, Nicolas Martinez-Majander, Sami Curtze, Maria Luisa Dell'Acqua, Guido Bigliardi, Nabila Wali, Paul J Nederkoorn, Dejana R Jovanovic, Visnja Padjen, Issa Metanis, Ronen R Leker, Giovanni Bianco, Carlo W Cereda, Rosario Pascarella, Marialuisa Zedde, Maria Maddalena Viola, Andrea Zini, João Nuno Ramos, João Pedro Marto, Heinrich J Audebert, Simon Trüssel, Henrik Gensicke, Stefan T Engelter, Christian H Nolte

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引用次数: 0

摘要

背景：颈内动脉（ICA）急性颅内闭塞可分为：(a) 涉及大脑中动脉或大脑前动脉近段的终末ICA闭塞（ICA-L/-T）和(b) 非终末ICA颅内闭塞伴Willis环通畅（ICA-I）。所有关于前方大血管闭塞的血管内治疗（EVT）随机对照试验都包括了 ICA-L/-T 闭塞患者，但关于 ICA-I 闭塞的 EVT 数据却很少。因此，我们的目的是评估与ICA-L/-T闭塞相比，EVT治疗ICA-I闭塞的有效性和安全性：方法：我们在一个大型国际多中心队列中搜索了2014年至2023年间接受EVT治疗的颅内ICA闭塞患者。根据ICA闭塞模式对患者进行分层，区分ICA-I和ICA-L/-T闭塞。分析了基线因素、技术（改良脑梗塞溶栓治疗量表（mTICI））和功能结果（3个月时的改良Rankin量表[mRS]）以及（无症状）颅内出血（[s]ICH）的发生率：在13453名患者中，有1825人（13.6%）患有孤立的ICA闭塞。559例（4.2%）患者的ICA闭塞模式为ICA-I型，1266例（9.4%）患者的ICA-L/-T型。两组患者的年龄（74 岁 vs 73 岁）、性别（女性：45.8% vs 49.0%）和卒中前功能独立性（mRS ⩽ 2 前：89.9% vs 92.2%）均无差异。ICA-I患者的卒中严重程度较低（入院时NIHSS：14 [7-19] 分 vs 17 [13-21] 分）。EVT在技术（mTICI2b/3：76.1%（ICA-I）vs 76.6%（ICA-L/-T）；aOR 1.01 [0.76-1.35]）和功能结果（调整分析中，mRS顺序移动cOR 1.01 [0.83-1.23]）方面同样成功。ICA-I患者的ICH（18.9% vs 34.5%；aOR 0.47 [0.36-0.62]）和sICH（4.7% vs 7.3%；aOR 0.58 [0.35-0.97]）发生率较低：结论：ICA-I型闭塞患者与ICA-L/-T型闭塞患者一样，可以安全、成功地进行EVT。

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Endovascular therapy in patients with acute intracranial non-terminal internal carotid artery occlusion (ICA-I).

Background: Acute intracranial occlusion of the internal carotid artery (ICA) can be distinguished into (a) occlusion of the terminal ICA, involving the proximal segments of the middle or anterior cerebral artery (ICA-L/-T) and (b) non-terminal intracranial occlusions of the ICA with patent circle of Willis (ICA-I). While patients with ICA-L/-T occlusion were included in all randomized controlled trials on endovascular therapy (EVT) in anterior large vessel occlusion, data on EVT in ICA-I occlusion is scarce. We thus aimed to evaluate effectiveness and safety of EVT in ICA-I occlusions in comparison to ICA-L/-T occlusions.

Methods: A large international multicentre cohort was searched for patients with intracranial ICA occlusion treated with EVT between 2014 and 2023. Patients were stratified by ICA occlusion pattern, differentiating ICA-I and ICA-L/-T occlusions. Baseline factors, technical (modified thrombolysis in cerebral infarction (mTICI) scale) and functional outcomes (modified Rankin scale [mRS] at 3 months) as well as rates of (symptomatic) intracranial hemorrhage ([s]ICH) were analyzed.

Results: Of 13,453 patients, 1825 (13.6%) had isolated ICA occlusion. ICA-occlusion pattern was ICA-I in 559 (4.2%) and ICA-L/-T in 1266 (9.4%) patients. Age (years: 74 vs 73), sex (female: 45.8% vs 49.0%) and pre-stroke functional independency (pre-mRS ⩽ 2: 89.9% vs 92.2%) did not differ between the groups. Stroke severity was lower in ICA-I patients (NIHSS at admission: 14 [7-19] vs 17 [13-21] points). EVT was similarly successful with respect to technical (mTICI2b/3: 76.1% (ICA-I) vs 76.6% (ICA-L/-T); aOR 1.01 [0.76-1.35]) and functional outcome (mRS ordinal shift cOR 1.01 [0.83-1.23] in adjusted analyses. Rates of ICH (18.9% vs 34.5%; aOR 0.47 [0.36-0.62] and sICH (4.7% vs 7.3%; aOR 0.58 [0.35-0.97] were lower in ICA-I patients.

Conclusion: EVT might be performed safely and similarly successful in patients with ICA-I occlusions as in patients with ICA-L/-T occlusions.

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.