Acute Endovascular Treatment of Patients With lschemic Stroke From Intracranial Large Vessel Occlusion and Extracranial Carotid Dissection

被引：22

作者：

Compagne, Kars C. J. ^{[1
,2
]}

Goldhoorn, R. B. ^{[3
]}

Uyttenboogaart, Maarten ^{[4
,5
]}

van Oostenbrugge, Robert J. ^{[3
,6
]}

van Zwam, Wim H. ^{[6
]}

van Doormaal, Pieter J. ^{[1
]}

Dippel, Diederik W. J. ^{[2
]}

van der Lugt, Aad ^{[1
,9
]}

Emmer, Bart J. ^{[8
]}

van Es, Adriaan C. G. M. ^{[1
]}

Majoie, Charles B. L. M. ^{[11
]}

Roos, Yvo B. W. E. M. ^{[12
]}

Boiten, Jelis ^{[21
]}

Vos, Jan Albert ^{[15
]}

Jansen, Ivo G. H. ^{[11
]}

Mulder, Maxim J. H. L. ^{[2
,9
]}

Kappelhof, Manon ^{[11
]}

Schonewille, Wouter J. ^{[14
]}

Coutinho, Jonathan M. ^{[12
]}

Wermer, Marieke J. H. ^{[16
]}

van Walderveen, Marianne A. A. ^{[17
]}

Staals, Julie ^{[3
]}

Hofmeijer, Jeannette ^{[18
]}

Martens, Jasper M. ^{[19
]}

Nijeholt, Geert J. Lycklama ^{[20
]}

Roozenbeek, Bob ^{[2
]}

de Bruijn, Sebastiaan F. ^{[22
]}

van Dijk, Lukas C. ^{[23
]}

van der Worp, H. Bart ^{[24
]}

Lo, Rob H. ^{[25
]}

van Dijk, Ewoud J. ^{[26
]}

Boogaarts, Hieronymus D. ^{[27
]}

de Kort, Paul L. M. ^{[29
]}

Peluso, Jo J. P. ^{[30
]}

van den Berg, Jan S. P. ^{[31
]}

van Hasselt, Boudewijn A. A. M. ^{[32
]}

Aerden, Leo A. M. ^{[33
]}

Dallinga, Ren J. ^{[34
]}

Eshghi, Omid ^{[36
]}

Schreuder, Tobien H. C. M. L. ^{[37
]}

Heijboer, Roel J. J. ^{[38
]}

Keizer, Koos ^{[39
]}

Yo, Lonneke S. F. ^{[40
]}

den Hertog, Heleen M. ^{[31
]}

Sturm, Emiel J. C. ^{[42
]}

Sprengers, Marieke E. S. ^{[11
]}

Jenniskens, Sjoerd F. M. ^{[28
]}

van den Berg, Rene ^{[11
]}

Yoo, Albert J. ^{[44
]}

Beenen, Ludo F. M. ^{[11
]}

机构：

[1] Erasmus MC, Dept Radiol & Nucl Med, Univ Med Ctr, Rotterdam, Netherlands

[2] Erasmus MC, Dept Neurol, Univ Med Ctr, Rotterdam, Netherlands

[3] Maastricht Univ, Dept Neurol, Med Ctr, Maastricht, Netherlands

[4] Univ Groningen, Univ Med Ctr Groningen, Dept Neurol, Groningen, Netherlands

[5] Univ Groningen, Depatment Radiol, Univ Med Ctr Groningen, Groningen, Netherlands

[6] Cardiovasc Res Inst Maastricht, Maastricht, Netherlands

[7] Maastricht Univ, Dept Radiol, Med Ctr, Maastricht, Netherlands

[8] Univ Amsterdam, Dept Radiol, Med Ctr, Amsterdam, Netherlands

[9] Erasmus MC, Dept Radiol, Univ Med Ctr, Rotterdam, Netherlands

[10] Erasmus MC, Dept Publ Hlth, Univ Med Ctr, Rotterdam, Netherlands

[11] Univ Amsterdam, Dept Radiol & Nucl Med, Amsterdam UMC, Amsterdam, Netherlands

[12] Univ Amsterdam, Dept Neurol, Amsterdam UMC, Amsterdam, Netherlands

[13] Univ Amsterdam, Dept Biomed Engn & Phys, Amsterdam UMC, Amsterdam, Netherlands

[14] St Antonius Hosp, Dept Neurol, Nieuwegein, Netherlands

[15] St Antonius Hosp, Dept Radiol, Nieuwegein, Netherlands

[16] Leiden Univ, Dept Neurol, Med Ctr, Leiden, Netherlands

[17] Leiden Univ, Dept Radiol, Med Ctr, Leiden, Netherlands

[18] Rijnstate Hosp, Dept Neurol, Arnhem, Netherlands

[19] Rijnstate Hosp, Dept Radiol, Arnhem, Netherlands

[20] Haaglanden MC, Dept Radiol, The Hague, Netherlands

[21] Haaglanden MC, Dept Neurol, The Hague, Netherlands

[22] HAGA Hosp, Dept Neurol, The Hague, Netherlands

[23] HAGA Hosp, Dept Radiol, The Hague, Netherlands

[24] Univ Med Ctr Utrecht, Dept Neurol, The Hague, Netherlands

[25] Univ Med Ctr Utrecht, Dept Radiol, Utrecht, Netherlands

[26] Radboud Univ Nijmegen, Dept Neurol, Med Ctr, Nijmegen, Netherlands

[27] Radboud Univ Nijmegen, Dept Neurosurg, Med Ctr, Nijmegen, Netherlands

[28] Radboud Univ Nijmegen, Dept Radiol, Med Ctr, Nijmegen, Netherlands

[29] Sint Elisabeth Hosp, Dept Neurol, Tilburg, Netherlands

[30] Sint Elisabeth Hosp, Dept Radiol, Tilburg, Netherlands

[31] Isala Klin, Dept Neurol, Zwolle, Netherlands

[32] Isala Klin, Dept Radiol, Zwolle, Netherlands

[33] Reinier Graaf Gasthuis, Dept Neurol, Delft, Netherlands

[34] Reinier Graaf Gasthuis, Dept Radiol, Delft, Netherlands

[35] Univ Med Ctr Groningen, Dept Neurol, Groningen, Netherlands

[36] Univ Med Ctr Groningen, Dept Radiol, Groningen, Netherlands

[37] Atrium Med Ctr, Dept Neurol, Heerlen, Netherlands

[38] Atrium Med Ctr, Dept Radiol, Heerlen, Netherlands

[39] Catharina Hosp, Dept Neurol, Eindhoven, Netherlands

[40] Catharina Hosp, Dept Radiol, Eindhoven, Netherlands

[41] Med Spectrum Twente, Dept Neurol, Enschede, Netherlands

[42] Med Spectrum Twente, Dept Radiol, Enschede, Netherlands

[43] Vrije Univ Amsterdam, Dept Radiol, Amsterdam UMC, Amsterdam, Netherlands

[44] Texas Stroke Inst, Dept Radiol, Plano, TX USA

来源：

FRONTIERS IN NEUROLOGY | 2019年 / 10卷

关键词：

ischemic stroke; carotid dissection; endovascular treatment; tandem lesion; thrombectomy; ACUTE ISCHEMIC-STROKE; ARTERY DISSECTION; MECHANICAL THROMBECTOMY; INTRAARTERIAL TREATMENT; MANAGEMENT; REPERFUSION; SCORE;

D O I：

10.3389/fneur.2019.00102

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Introduction: Carotid artery dissection (CAD) and atherosclerotic carotid artery occlusion (ACAO) are major causes of a tandem occlusion in patients with intracranial large vessel occlusion (LVO). Presence of tandem occlusions may hamper intracranial access and potentially increases the risk of procedural complications of endovascular treatment (EVT). Our aim was to assess neurological, functional and technical outcome and complications of EVT for intracranial LVO in patients with CAD in comparison to patients with ACAO and to patients without CAD or ACAO. Methods: We analyzed data of the MR CLEAN trial intervention arm and MR CLEAN Registry, acquired in 16 Dutch EVT-centers. Primary outcome was the change in stroke severity by comparing the National Institute of Health Stroke Scale (NIHSS) score at 24-48 h after treatment vs. baseline. Secondary outcomes included reperfusion rate and symptomatic intracranial hemorrhage (sICH). We compared outcomes and complications between patients with CAD vs. patients with ACAO and patients without CAD or ACAO. Results: In total, we identified 74 (4.7%) patients with CAD, 92 (5.9%) patients with ACAO and 1398 (89.4%) patients without CAD or ACAO. Neurological improvement at short-term after EVT in patients with CAD was significantly better compared to ACAO (raw mean -5 vs. mean -1 NIHSS point; p = 0.03) and did not differ compared to patients without CAD or ACAO (-4 NIHSS points; p = 0.62). Rates of successful reperfusion in patients with CAD (47%) was comparable to patients with ACAO (47%; p = 1.00), but was less often achieved compared to patients without CAD or ACAO (58%; p = 0.08). Occurrence of sICH did not differ significantly between CAD patients (5%) and ACAO (11%; p = 0.33) or without CAD/ACAO (6%; p = 1.00). Conclusion: EVT in patients with intracranial LVO due to CAD results in neurological improvement comparable to patients without tandem occlusions. Therefore, carotid artery dissection by itself should not be a contraindication for endovascular treatment in stroke patients with intracranial large vessel occlusion. Although more challenging endovascular procedures are to be suspected in both patients with CAD or ACAO, accurate distinction between CAD and ACAO might influence clinical decision making as better clinical outcome can be expected in patients with CAD.

引用

页数：9

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