[1]张艳,王幼萌,王福星,等.串联病变对急性前循环大血管闭塞性缺血性脑卒中血管内治疗预后的影响[J].卒中与神经疾病杂志,2024,31(06):517-520530.[doi:10.3969/j.issn.1007-0478.2024.06.001]
 Zhang Yan,Wang Youmeng,Wang Fuxing,et al.Effect of tandem lesion on the prognosis of endovascular treatment for acute anterior circulation large vessel occlusion ischemic stroke[J].Stroke and Nervous Diseases,2024,31(06):517-520530.[doi:10.3969/j.issn.1007-0478.2024.06.001]
点击复制

串联病变对急性前循环大血管闭塞性缺血性脑卒中血管内治疗预后的影响()
分享到:

《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第31卷
期数:
2024年06期
页码:
517-520530
栏目:
血管内治疗
出版日期:
2024-12-20

文章信息/Info

Title:
Effect of tandem lesion on the prognosis of endovascular treatment for acute anterior circulation large vessel occlusion ischemic stroke
文章编号:
1007-0478(2024)06-0517-05
作者:
张艳王幼萌王福星陈巨罗王国防
236000 安徽省阜阳市人民医院[张艳 王幼萌 王福星 陈巨罗 王国防(通信作者)]
Author(s):
Zhang Yan Wang Youmeng Wang Fuxing et al.
Fuyang People's Hospital, Fuyang Anhui 236000
关键词:
前循环串联病变 颈动脉支架植入 血管再通 出血性转化 预后
Keywords:
Anterior circulation tandem lesion Carotid artery stent implantation Vascular recanalization Hemorrhagic transformation Prognosis
分类号:
R743.3
DOI:
10.3969/j.issn.1007-0478.2024.06.001
文献标志码:
A
摘要:
目的 探讨串联病变对急性前循环大血管闭塞性缺血性脑卒中血管内治疗预后的影响。方法 收集2021年6月-2022年9月在阜阳市人民医院接受急性期血管内治疗的前循环大血管闭塞性缺血性脑卒中患者的临床资料,应用二分类Logistic回归分析串联病变对前循环大血管闭塞性缺血性脑卒中血管内治疗预后的影响。结果 本研究共入组14例(15.56%)串联病变患者,其中11例(78.57%)发病机制为动脉粥样硬化,3例(21.43%)为血管夹层; 10例(71.43%)采用逆行开通的方法,11例(78.57%)同期行颈动脉支架植入,3例(21.43%)合并出血性转化,12例(85.71%)实现完全血管再通,6例(42.86%)预后良好; 二分类Logistic回归分析显示,串联病变(OR=1.119,95%CI=0.182~6.880,P=0.903)对急性前循环大血管闭塞性缺血性脑卒中血管内治疗的预后无显著影响,而基线美国国立卫生研究院卒中量表(National institute of health stroke scale,NIHSS)评分高(OR=1.230,95%CI=1.099~1.377,P<0.001)、穿刺至血管再通时间长(OR=1.034,95%CI=1.010~1.059,P=0.006)和出血性转化(OR=22.326,95%CI=2.673~186.474,P=0.004)是导致其神经功能结局转归不良的独立危险因素。结论 串联病变对急性前循环大血管闭塞性缺血性脑卒中血管内治疗的预后无显著影响,而基线NIHSS评分高、穿刺至血管再通时间长和出血性转化是导致其转归不良的独立危险因素。
Abstract:
ObjectiveTo explore effect of tandem lesion on the prognosis of endovascular treatment for acute anterior circulation large vessel occlusion ischemic stroke.Methods The clinical data of patients with anterior circulation large vessel occlusive ischemic stroke who received acute endovascular treatment in Fuyang People's Hospital from June 2021 to September 2022 were collected. Binary logistic regression was applied to analyze the impact of tandem lesion on the prognosis of endovascular treatment for acute anterior circulation large vessel occlusion ischemic stroke.Results In this study, 14 patients(15.56%)with tandem lesions were enrolled. Among them, 11(78.57%)had atherosclerosis as the pathogenesis, 3(21.43%)had vascular dissection, 10(71.43%)had retrograde patency, 11(78.57%)had carotid stent implantation at the same time, 3(21.43%)had hemorrhagic transformation, 12(85.71%)had complete vascular recanalization, and 6(42.86%)had good prognosis. The results of binary logistic regression analysis showed that tandem lesions(OR=1.119, 95% CI=0.182~6.880, P=0.903)had no significant impact on the prognosis of endovascular treatment for acute anterior circulation large vessel occlusion ischemic stroke. The high baseline NIHSS score(OR=1.230, 95% CI=1.099~1.377, P<0.001),long time from puncture to vascular recanalization(OR=1.034, 95% CI=1.010~1.059, P=0.006),and hemorrhagic transformation(OR=22.326, 95% CI=2.673~186.474, P=0.004)are independent risk factors for poor neurological outcomes.Conclusion Tandem lesion have no significant impact on the prognosis of endovascular treatment for acute anterior circulation large vessel occlusion ischemic stroke, while high baseline NIHSS score, long puncture to vessel recanalization time, and hemorrhagic transformation are independent risk factors for poor prognosis.

参考文献/References:

[1] Poppe AY,Jacquin G,Roy D,et al.Tandem carotid lesions in acute ischemic stroke:mechanisms, therapeutic challenges, and future directions[J].AJNR Am J Neuroradiol,2020,41(7):1142-1148.
[2] Rangel-Castilla L,Rajah GB,Shakir HJ,et al.Management of acute ischemic stroke due to tandem occlusion:should endovascular recanalization of the extracranial or intracranial occlusive lesion be done first?[J].Neurosurg Focus,2017,42(4):E16.
[3] Rubiera M,Ribo M,Delgado-Mederos R,et al.Tandem internal carotid artery/middle cerebral artery occlusion:an independent predictor of poor outcome after systemic thrombolysis[J].Stroke,2006,37(9):2301-2305.
[4] Paciaroni M,Agnelli G,Caso V,et al.Intravenous thrombolysis for acute ischemic stroke associated to extracranial internal carotid artery occlusion:the ICARO-2 study[J].Cerebrovasc Dis,2012,34(5/6):430-435.
[5] Powers WJ,Rabinstein AA,Ackerson T,et al.2018 guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American heart association/American stroke association[J].Stroke,2018,49(3):e46-e110.
[6] Zaidat OO,Yoo AJ,Khatri P,et al.Recommendations on angiographic revascularization grading standards for acute ischemic stroke:a consensus statement[J].Stroke,2013,44(9):2650-2663.
[7] Yang D,Shi ZH,Lin M,et al.Endovascular retrograde approach may be a better option for acute tandem occlusions stroke[J].Interv Neuroradiol,2019,25(2):194-201.
[8] Sojka M,Szmygin M,Pyra K,et al.Effectiveness and safety of ICA stenting in conjunction with mechanical thrombectomy(antegrade approach)in acute ischaemic stroke patients due to tandem occlusion[J].Neurol Neurochir Pol,2020,54(5):426-433.
[9] Zapata-Arriaza E,Medina-Rodriguez M,Ortega-Quintanilla J,et al. Relevance of carotid reocclusion in tandem lesions[Z], 2022.
[10] Bracco S,Zanoni M,Casseri T,et al.Endovascular treatment of acute ischemic stroke due to tandem lesions of the anterior cerebral circulation:a multicentric Italian observational study[J].Radiol Med,2021,126(6):804-817.
[11] Wilson MP,Murad MH,Krings T,et al.Management of tandem occlusions in acute ischemic stroke—intracranial versus extracranial first and extracranial stenting versus angioplasty alone:a systematic review and meta-analysis[J].J Neurointerv Surg,2018,10(8):721-728.
[12] Garg A,Farooqui M,Zevallos CB,et al. Carotid artery angioplasty versus stenting for management of acute tandem occlusions[Z], 2021: 117588.
[13] Da Ros V,Scaggiante J,Sallustio F,et al.Carotid stenting and mechanical thrombectomy in patients with acute ischemic stroke and tandem occlusions:antithrombotic treatment and functional outcome[J].AJNR Am J Neuroradiol,2020,41(11):2088-2093.
[14] Papanagiotou P,Haussen DC,Turjman F,et al.Carotid stenting with antithrombotic agents and intracranial thrombectomy leads to the highest recanalization rate in patients with acute stroke with tandem lesions[J].JACC Cardiovasc Interv,2018,11(13):1290-1299.
[15] Jadhav AP,Zaidat OO,Liebeskind DS,et al.Emergent management of tandem lesions in acute ischemic stroke[J].Stroke,2019,50(2):428-433.
[16] Feil K,Herzberg M,Dorn F,et al.Tandem lesions in anterior circulation stroke:analysis of the German stroke registry-endovascular treatment[J].Stroke,2021,52(4):1265-1275.
[17] Marnat G,Finistis S,Moreno R,et al. Aspirin versus aggressive antiplatelet therapy for acute carotid stenting plus thrombectomy in tandem occlusions:ETIS registry results[Z], 2022.
[18] Nolan NM,Regenhardt RW,Koch MJ,et al.Treatment approaches and outcomes for acute anterior circulation stroke patients with tandem lesions[J].J Stroke Cerebrovasc Dis,2021,30(2):105478.
[19] Marko M,Cimflova P,Poppe AY,et al.Management and outcome of patients with acute ischemic stroke and tandem carotid occlusion in the ESCAPE-NA1 trial[J].J Neurointerv Surg,2022,14(5):neurintsurg-neurint2021.
[20] Gory B,Haussen DC,Piotin M,et al.Impact of intravenous thrombolysis and emergent carotid stenting on reperfusion and clinical outcomes in patients with acute stroke with tandem lesion treated with thrombectomy:a collaborative pooled analysis[J].Eur J Neurol,2018,25(9):1115-1120.
[21] Soize S,Kadziolka K,Estrade L,et al.Outcome after mechanical thrombectomy using a stent retriever under conscious sedation: comparison between tandem and single occlusion of the anterior circulation[J].J Neuroradiol,2014,41(2):136-142.
[22] Heck DV,Brown MD.Carotid stenting and intracranial thrombectomy for treatment of acute stroke due to tandem occlusions with aggressive antiplatelet therapy may be associated with a high incidence of intracranial hemorrhage[J].J Neurointerv Surg,2015,7(3):170-175.
[23] Mbroh J,Poli K,Tünnerhoff J,et al. Comparison of risk factors,safety,and efficacy outcomes of mechanical thrombectomy in posterior vs[Z], 2021: 687134.
[24] Goyal M,Menon BK,van Zwam WH,et al.Endovascular thrombectomy after large-vessel ischaemic stroke:a meta-analysis of individual patient data from five randomised trials[J].Lancet,2016,387(10029):1723-1731.
[25] Ospel JM,Qiu W,Menon BK,et al.Radiologic patterns of intracranial hemorrhage and clinical outcome after endovascular treatment in acute ischemic stroke:results from the ESCAPE-NA1 trial[J].Radiology,2021,300(2):402-409.
[26] Hao YG,Yang D,Wang HM,et al.Predictors for symptomatic intracranial hemorrhage after endovascular treatment of acute ischemic stroke[J].Stroke,2017,48(5):1203-1209.
[27] Kaesemann P,Thomalla G,Cheng B,et al. Impact of severe extracranial ICA stenosis on MRI perfusion and diffusion parameters in acute ischemic stroke[Z], 2014: 254.
[28] Zapata-Arriaza E,de Albóniga-Chindurza A,Ortega-Quintanilla J,et al.Clinical outcomes of mechanical thrombectomy in stroke tandem lesions according to intracranial occlusion location[J].J Stroke,2021,23(1):124-127.

更新日期/Last Update: 2024-12-20