Endovascular versus Best Medical Treatment for Acute Carotid Occlusion BelOw Circle of Willis (ACOBOW): The ACOBOW Study

被引：2

作者：

Meyer, Lukas ^{[1
]}

Broocks, Gabriel ^{[1
]}

Alexandrou, Maria ^{[2
]}

Luettich, Alex ^{[3
]}

Larrea, Jose angel ^{[3
]}

Schwindt, Wolfram ^{[4
,5
]}

Kraehling, Hermann ^{[4
,5
]}

Naziri, Weis ^{[6
]}

Behme, Daniel ^{[7
]}

Thormann, Maximilian ^{[7
]}

Styczen, Hanna ^{[8
]}

Deuschl, Cornelius ^{[8
]}

Kabbasch, Christoph ^{[9
]}

Zaeske, Charlotte ^{[9
]}

Weyland, Charlotte ^{[10
]}

Petzsche, Moritz Roman Hernandez ^{[11
]}

Maegerlein, Christian ^{[11
]}

Zimmermann, Hanna ^{[12
]}

Ernst, Marielle ^{[13
]}

Jamous, Ala ^{[13
]}

Gamazo, Manuel Moreu ^{[14
]}

Perez-Garcia, Carlos ^{[14
]}

Navia, Pedro ^{[15
]}

Prieto, Andres Fernandez ^{[15
]}

Yeo, Leonard ^{[16
,18
]}

Tan, Benjamin ^{[16
,18
]}

Gopinathan, Anil ^{[17
,18
]}

Siebert, Eberhard ^{[19
]}

Miszczuk, Milena ^{[19
]}

Schob, Stefan ^{[20
]}

Sporns, Peter ^{[1
,21
,22
]}

Parra, Joaquin Zamarro ^{[23
]}

Parrilla, Guillermo ^{[24
]}

Arnberg, Fabian ^{[25
,26
]}

Andersson, Tommy ^{[25
,26
,27
]}

Zelenak, Kamil ^{[28
,29
]}

Papanagiotou, Panagiotis ^{[2
,30
]}

Psychogios, Marios ^{[22
]}

Moehlenbruch, Markus ^{[10
]}

Kemmling, Andre ^{[31
]}

Dorn, Franziska ^{[32
]}

Elsharkawy, Mohamed ^{[33
]}

Fiehler, Jens ^{[1
]}

Stracke, Christian Paul ^{[1
,4
,5
]}

机构：

[1] Univ Med Ctr Hamburg Eppendorf, Dept Diag & Intervent Neuroradiol, Martinistr 52, D-20246 Hamburg, Germany

[2] Hosp Bremen Mitte, Dept Diag & Intervent Neuroradiol, Bremen, Germany

[3] Donostia Univ Hosp, Dept Radiol, Intervent Neuroradiol Sect, Donostia San Sebastian, Spain

[4] Univ Munster, Clin Radiol, Sect Intervent Radiol, Munster, Germany

[5] Univ Hosp Munster, Munster, Germany

[6] Westpfalz Klinikum, Dept Neuroradiol, Kaiserslautern, Germany

[7] Otto von Guericke Univ Klinikum Magdeburg, Dept Neuroradiol, Magdeburg, Germany

[8] Univ Hosp Essen, Inst Diag & Intervent Radiol & Neuroradiol, Essen, Germany

[9] Univ Cologne, Dept Neuroradiol, Cologne, Germany

[10] Univ Hosp Aachen, Dept Neuroradiol, Aachen, Germany

[11] Tech Univ Munich, Sch Med, Klinikum rechts Isar, Dept Diag & Intervent Neuroradiol, Munich, Germany

[12] Ludwig Maximilians Univ Munchen, Univ Hosps, Inst Neuroradiol, Munich, Germany

[13] Univ Med Ctr Goettingen, Dept Diag & Intervent Neuroradiol, Gottingen, Germany

[14] Hosp Clin San Carlos, Dept Radiol, Intervent Neuroradiol, Madrid, Spain

[15] Hosp Univ La Paz, Dept Neuroradiol, Madrid, Spain

[16] Natl Univ Hlth Syst, Dept Med, Div Neurol, Singapore, Singapore

[17] Natl Univ Hlth Syst, Dept Diag Imaging, Div Intervent Radiol, Singapore, Singapore

[18] Natl Univ Singapore, Natl Univ Hlth Syst, Yong Loo Lin Sch Med, Singapore, Singapore

[19] Charite Univ Med Berlin, Inst Neuroradiol, Berlin, Germany

[20] Univ Hosp Halle Saale, Dept Neuroradiol, Clin & Policlin Radiol, Halle, Germany

[21] Stadtspital Zurich, Dept Radiol & Neuroradiol, Zurich, Switzerland

[22] Univ Hosp Basel, Dept Diag & Intervent Neuroradiol, Basel, Switzerland

[23] Hosp Clin Univ Virgen Arrixaca, Depts Intervent Neuroradiol, Murcia, Spain

[24] Dept Neurol Hosp Clin Univ Virgen Arrixaca, Neurol, Murcia, Spain

[25] Karolinska Univ Hosp, Dept Neuroradiol, Stockholm, Sweden

[26] Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden

[27] AZ Groeninge, Dept Med Imaging, Kortrijk, Belgium

[28] Comenius Univ Jessenius, Dept Radiol, Fac Med, Martin, Slovakia

[29] Univ Hosp, Martin, Slovakia

[30] Natl & Kapodistrian Univ Athens, Aretaie Univ Hosp, Dept Anesthesiol, Athens 11528, Greece

[31] Univ Hosp Giessen & Marburg, Dept Neuroradiol, Marburg, Germany

[32] Univ Hosp Bonn, Dept Neuroradiol, Bonn, Germany

[33] Alfried Krupp Hosp, Dept Neuroradiol, Essen, Germany

来源：

RADIOLOGY | 2025年 / 314卷 / 01期

关键词：

ACUTE ISCHEMIC-STROKE; INTRAVENOUS THROMBOLYSIS; THERAPY;

D O I：

10.1148/radiol.240293

中图分类号：

R8 [特种医学]; R445 [影像诊断学];

学科分类号：

1002 ; 100207 ; 1009 ;

摘要：

Background: Symptomatic acute occlusions of the internal carotid artery (ICA) below the circle of Willis can cause a variety of stroke symptoms, even if the major intracranial cerebral arteries remain patent; however, outcome and safety data are limited. Purpose: To compare treatment effects and procedural safety of endovascular treatment (EVT) and best medical treatment (BMT) in patients with symptomatic acute occlusions of the ICA below the circle of Willis. Materials and Methods: This retrospective, multicenter cohort study from 22 comprehensive stroke centers in Europe and Asia includes patients treated between January 1, 2008, and December 31, 2022. Functional (modified Rankin Scale [mRS]) and clinical (National Institutes of Health Stroke Scale [NIHSS]) outcomes, safety measures (symptomatic intracerebral hemorrhage), mortality, and procedural complications were assessed. Results: A total 354 patients met the inclusion criteria (median age, 72 years [IQR, 60-81 years]; median NIHSS, 13 [IQR, 7-19]). Most frequent occlusions were in the C1 segment (243 of 354; 68.6%). Of 354 patients, 82.2% (291 patients) were administered EVT. In the overall population, favorable outcomes (mRS 0-2), mortality, and symptomatic intracerebral hemorrhage occurred in 40.6% (108 of 266 patients), 25.2% (67 of 266 patients), and 7.1% (25 of 350 patients), respectively. After adjustment, no statistically significant difference in functional outcome was observed (adjusted odds ratio [AOR], 0.82 [95% CI: 0.31, 2.12]; average treatment effect, -12.7%; P = .19) in the EVT compared with BMT group. Symptomatic intracerebral hemorrhage (average treatment effect, -0.28%; P = .95) and mortality did not differ between both groups (average treatment effect, -17.1%; P = .07). EVT resulted in complete recanalization of the occlusion in 80.9% (229 of 283) of cases. Periprocedural distal embolization occurred in 27.8% (81 of 291 patients) and was associated with poor outcomes (AOR, 0.41; 95% CI: 0.18, 0.93; P = .03). Conclusion: EVT did not reveal a favorable treatment effect over BMT, and both therapies were safe. EVT had a risk for periprocedural distal embolization associated with poor outcomes. (c) RSNA, 2025

引用

页数：10

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