Purpose

Endovascular reperfusion therapy (ERT) in patients with intracranial atherosclerosis (ICAS)-related acute large vessel occlusion (ALVO) may require different strategies based on the underlying culprit plaque lesion. This study investigated the effectiveness and safety of direct stent placement in ICAS-related ALVO compared with initially attempted mechanical thrombectomy (MT) with or without rescue treatment.

Methods

Direct stenting for ICAS-related ALVO was performed in 30 consecutive patients between January 1, 2012, and December 31, 2018. As a control for comparison, MT with or without rescue stenting for patients with ICAS-related ALVO was performed in 73 consecutive patients during the same period. Clinical outcomes were assessed by measuring modified Rankin Scale (mRS) at 90 days.

Results

Patients who underwent direct stenting and those who underwent MT with or without rescue stenting showed no significant differences in baseline characteristics. There was a higher proportion of patients with mRS 0–2 at 90 days in the direct stenting group than in the MT with or without rescue stenting group [24 (80.0%) vs. 34 (46.6%); p = 0.004]. Successful recanalization to modified thrombolysis in cerebral infarction category 2b or 3 was achieved in 93.3% of patients who underwent direct stenting, and in 90.4% of patients who underwent MT with or without rescue stenting.

Conclusion

Direct stenting is an effective and safe option for ICAS-related ALVO. Further studies are needed to confirm that endovascular treatments are effective and safe in patients with ALVO and underlying ICAS.

中文翻译：

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颅内动脉粥样硬化相关急性大血管闭塞的直接支架置入术。

目的

颅内动脉粥样硬化 (ICAS) 相关的急性大血管闭塞 (ALVO) 患者的血管内再灌注治疗 (ERT) 可能需要根据潜在的罪魁祸首斑块病变采取不同的策略。本研究调查了直接支架置入 ICAS 相关 ALVO 与最初尝试的机械血栓切除术 (MT) 有或没有抢救治疗的有效性和安全性。

方法

2012 年 1 月 1 日至 2018 年 12 月 31 日期间，连续 30 名患者对 ICAS 相关 ALVO 进行了直接支架置入术。 作为比较的对照，对 ICAS 相关 ALVO 患者进行了 MT 加或不加抢救支架植入术的连续 73 例患者在同一时期。通过在 90 天时测量改良的 Rankin 量表 (mRS) 来评估临床结果。

结果

接受直接支架置入术的患者和接受或不置入救援支架术的 MT 的患者在基线特征方面没有显着差异。与 MT 有或无救援支架组相比，直接支架组在 90 天时 mRS 0-2 的患者比例更高 [24 (80.0%) vs. 34 (46.6%); p  = 0.004]。93.3% 接受直接支架置入术的患者和 90.4% 接受或不置入救援支架术的 MT 患者成功再通至 2b 或 3 类脑梗死的改良溶栓治疗。

结论

直接支架置入术是 ICAS 相关 ALVO 的有效且安全的选择。需要进一步的研究来证实血管内治疗对 ALVO 和潜在 ICAS 患者是有效和安全的。