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Endovascular Treatment for Acute Tandem Occlusion Stroke: Results from Case Series of 17 Patients.
Annals of Indian Academy of Neurology ( IF 1.7 ) Pub Date : 2020-02-15 , DOI: 10.4103/aian.aian_464_18
Luu Vu-Dang 1, 2 , Quang-Anh Nguyen 1, 2 , Trang Nguyen-Thi-Thu 2 , Anh-Tuan Tran 2 , Cong Le-Chi 2 , Kien Le-Hoang 2 , Thien Nguyen-Tat 2 , An Nguyen-Huu 1 , Thong Pham-Minh 1, 2 , Thien Chu-Dinh 3 , Dinh-Toi Chu 4
Affiliation  

BACKGROUND AND PURPOSE Tandem occlusive lesion, a major challenge for thrombectomy in acute anterior circulation strokes, is poorly represented in randomized trials. This study demonstrates the findings of thrombectomy in tandem occlusion and comparative analysis of two treatment groups (extracranial versus intracranial first subgroup). PATIENTS AND METHODS We enrolled and divided 17 patients with acute tandem ischemic stroke who received endovascular treatment into two groups. Group 1 with completed (100%) internal carotid artery (ICA) occlusion was treated by an extracranial stent, whereas Group 2 with severe (70%-99%) ICA occlusion was prioritized with intracranial thrombectomy. Data of clinical parameters, imaging and angiographic results, periprocedural complications, and results after 3 months were collected and analyzed. RESULTS The mean age of patients was 70.2 ± 8.8 years, and males accounted for 94.1%. The National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT Score (ASPECTS) baseline were 16.6 ± 4.2 and 7.6 ± 1.1, respectively, with occlusive side was 52.9% on the right. Group 1 including ten cases (58.8%) was treated extracranial lesion with carotid stent before intracranial thrombectomy, and Group 2 with seven cases (41.2%) was prioritized intracranial thrombectomy. In total 17 procedures, there were ten stent retrievers (58.8%), four aspirations (23.5%), and three Solumbra (17.7%). No re-occlusion of carotid stent postoperation was recorded. The good revascularization (thrombolysis in cerebral infarction 2b-3) was archived in 82.4% of patients, while symptomatic hemorrhage was seen in 2 cases (11.8%). Three months after treatment, patients with favorable clinical outcome (Modified Rankin Scale ≤2) accounted for 47.1%. CONCLUSION Our study determined a promising outcome with reasonable good recanalization and clinical recovery for endovascular intervention in tandem ischemic. In the subgroup of treatment, "extracranial stent first" had more complex disease with completed ICA occlusion which required longer procedure time may lead to worse outcome.

中文翻译:

急性串联闭塞性卒中的血管内治疗:17 例患者病例系列的结果。

背景和目的串联闭塞性病变是急性前循环卒中血栓切除术的主要挑战,但在随机试验中的代表性不足。本研究展示了串联闭塞血栓切除术的结果以及两个治疗组(颅外与颅内第一亚组)的比较分析。患者与方法 我们招募了 17 名接受血管内治疗的急性串联缺血性卒中患者并将其分为两组。完成(100%)颈内动脉(ICA)闭塞的第 1 组采用颅外支架治疗,而严重(70%-99%)颈内动脉闭塞的第 2 组优先采用颅内血栓切除术。收集和分析临床参数、影像学和血管造影结果、围手术期并发症和3个月后结果的数据。结果患者平均年龄70.2±8.8岁,男性占94.1%。美国国立卫生研究院卒中量表和阿尔伯塔省卒中计划早期 CT 评分 (ASPECTS) 基线分别为 16.6 ± 4.2 和 7.6 ± 1.1,右侧闭塞侧为 52.9%。第1组10例(58.8%)在颅内取栓前行颈动脉支架治疗颅外病变,第2组7例(41.2%)优先行颅内取栓。在总共 17 个程序中,有 10 个支架取栓器 (58.8%)、4 个抽吸器 (23.5%) 和 3 个 Solumbra (17.7%)。没有记录到术后颈动脉支架再次闭塞。82.4% 的患者有良好的血运重建(脑梗死溶栓 2b-3),而有 2 例(11.8%)有症状性出血。治疗三个月后,临床结果良好(改良Rankin量表≤2)的患者占47.1%。结论 我们的研究确定了一个有希望的结果,具有合理的良好再通和临床恢复,用于串联缺血的血管内干预。在治疗亚组中,“颅外支架优先”疾病更复杂,ICA完全闭塞,需要更长的手术时间,可能导致更差的结果。
更新日期:2020-02-05
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