Endovascular treatment of acute ischemic stroke due to tandem lesions of the anterior cerebral circulation: a multicentric Italian observational study

被引：30

作者：

Bracco, Sandra ^{[1
]}

Zanoni, Matteo ^{[2
]}

Casseri, Tommaso ^{[1
]}

Castellano, Davide ^{[5
]}

Cioni, Samuele ^{[1
]}

Vallone, Ignazio Maria ^{[1
]}

Gennari, Paola ^{[1
]}

Mazzei, Maria Antonietta ^{[2
]}

Romano, Daniele Giuseppe ^{[6
]}

Piano, Mariangela ^{[4
]}

Comelli, Chiara ^{[5
]}

Tassi, Rossana ^{[7
]}

Ciceri, Elisa Francesca Maria ^{[3
]}

机构：

[1] Azienda Osped Univ Senese, Dept Neurol & Human Movement Sci, Unit Intervent Neuroradiol, Siena, Italy

[2] Univ Siena, Azienda Osped Univ Senese, Santa Maria Scotte Hosp, Unit Diagnost Imaging,Dept Med Surg & Neuro Sci, Viale M Bracci 16, I-53100 Siena, Italy

[3] Azienda Osped Univ Integrata Verona, Neuroradiol Dept, Verona, Italy

[4] Azienda Socio Sanit Terrr Grande Osped Metropolit, Neuroradiol Dept, Milan, Italy

[5] Azienda Sanitaria Locale Citta Torino, S Giovanni Bosco Hosp, Dept Intervent Radiol & Neuroradiol, Turin, Italy

[6] Azienda Ospedal Univ San Giovanni Dio & Ruggi Ara, Neuroradiol Unit, Salerno, Italy

[7] Azienda Osped Univ Senese, Stroke Unit, Siena, Italy

来源：

RADIOLOGIA MEDICA | 2021年 / 126卷 / 06期

关键词：

Acute ischemic stroke; Endovascular therapy; Stroke mechanical thrombectomy; Carotid plaque; Carotid dissection; Carotid stenting; STENT-RETRIEVER THROMBECTOMY; LARGE VESSEL OCCLUSION; CONSCIOUS SEDATION; GENERAL-ANESTHESIA; CLINICAL-OUTCOMES; ARTERY OCCLUSION; TRIAL; REVASCULARIZATION; MANAGEMENT; THERAPY;

D O I：

10.1007/s11547-020-01331-7

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：

Purpose Acute ischemic stroke (AIS) due to tandem lesions (TLs) of extracranial Internal Carotid Artery and Anterior Cerebral Circulation are challenging for endovascular treatment (EVT). This study aims to evaluate feasibility, safety and efficacy of EVT for TLs' AIS, with or without emergent carotid artery stenting (eCAS), in a real-life scenario. Methods Retrospective review of prospectively collected non-randomized thrombectomy databases from five stroke centers between 2015 and 2019. Consecutive patients with TLs' AIS were selected. Clinical, neuroimage and procedure features, as well as antiplatelet therapy regimen, were evaluated. Primary outcome was 90-day mRS <= 2. Secondary outcomes included: mTICI score 2b-3, extracranial recanalization, procedural complications, symptomatic intracerebral hemorrhage (SICH) and 90-day mortality. Results Two hundred twenty-seven patients were enrolled (67.8% males; mean age 65.9 +/- 12.9 years). We obtained mTICI 2b-3 in 77.1%, extracranial recanalization in 86.8%, 90-day mRS (available in 201/227 cases) <= 2 in 49.8%. Procedural complications occurred in 16.7%, SICH in 9.7%; 90-day mortality rate (available in 201/227 cases) was 14.4%. The strongest predictors of good clinical outcome were young age (p < 0.0001), low baseline NIHSS (p = 0.008), high baseline ASPECTS (p < 0.0001), good collateral flow (p = 0.013) and extracranial recanalization (p = 0.001). The most significant predictors of SICH were low baseline ASPECTS (p < 0.0001), occurrence of complications (p < 0.0001) and eCAS (p = 0.002). Conclusion In our real-life series, the EVT for TLs' AIS was feasible, safe and effective in improving 90-day functional outcome with acceptable morbi-mortality rates. ECAS increased the risk of SICH, independently from the antiplatelet therapy regimen.

引用

页码：804 / 817

页数：14

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