Angioplasty and/or stenting after thrombectomy in patients with underlying intracranial atherosclerotic stenosis

医学 血管成形术 神经组阅片室 狭窄 内科学 心脏病学 无症状的 神经学 冲程(发动机) 放射科 外科 机械工程 精神科 工程类
作者
Chuanjie Wu,Wansheng Chang,Di Wu,Changming Wen,Jing Zhang,Rui Xu,Xin Liu,Yajun Lian,Nanchang Xie,Chuanhui Li,Wenjing Wei,Wenbo Zhao,Zhengfei Ma,Zongen Gao,Xunming Ji
出处
期刊:Neuroradiology [Springer Science+Business Media]
卷期号:61 (9): 1073-1081 被引量:30
标识
DOI:10.1007/s00234-019-02262-5
摘要

To investigate the imaging and clinical outcomes of emergent angioplasty and/or stenting or neither in patients of emergent large-vessel occlusion (ELVO) with underlying severe intracranial atherosclerotic stenosis (ICAS). In this multicenter prospective cohort study, we included patients of ELVO with underlying ICAS. Patients received emergent angioplasty and/or stenting or neither after mechanical thrombectomy at the interventionists’ discretion. The primary outcome was recanalization rate at 24 h, which was defined as a modified arterial occlusive lesion score of 2 or 3. A total of 113 consecutive patients with underlying ICAS > 70% in anterior cerebral circulation were enrolled in this study. Of these, 81 (71.7%) received emergent angioplasty and/or stenting after thrombectomy. Patients in the emergent angioplasty and/or stenting group were significantly more likely to have recanalization at 24 h (adjusted OR [aOR], 3.782; 95% confidence interval [CI], 1.821–9.125; P = 0.02) and less likely to have early neurologic deterioration (aOR, 0.299; 95% CI, 0.110–0.821; P = 0.01). However, emergent angioplasty and/or stenting was not significantly associated with symptomatic intracranial hemorrhage (aOR, 0.710; 95% CI, 0.199–2.622; P = 0.67), asymptomatic intracranial hemorrhage (aOR, 1.325; 95% CI, 0.567–3.031; P = 0.81), death at 90 days (aOR, 0.581; 95% CI, 0.186–2.314; P = 0.41), and functional independence at 90 days (aOR, 1.752; 95% CI, 0.774–3.257; P = 0.16), compared with patients that received neither. Emergent angioplasty and/or stenting is possible in patients of ELVO with ICAS and may reduce the risk of reocclusion and early neurologic deterioration with no increased risk of intracranial hemorrhage and death than those received neither.
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