The value of endovascular recanalization in patients with non-acute large artery occlusion with impaired anterior circulation perfusion
XIANG Shiqi1, ZHANG Zhou2, GAO Xiaoping2, YANG Jianfeng3
1. The General Hospital of Hunan University of Medicine, huaihua 418000; 2. The First Affiliated Hospital of Hunan Normal University/Hunan Provincial Hospital, Changsha 410005; 3. School of Medicine, Hunan Normal University, Changsha 410013
Abstract：Objective Investigating the improvement of imaging and clinical symptoms of endovascular recanalization for large artery occlusion (LAO) with impaired anterior circulation perfusion and evaluating the safety and efficacy of endovascular opening therapy in multiple dimensions. Methods patients with non-acute LAO with impaired anterior circulation perfusion in Hunan Provincial People’s Hospital were included from January 2020 to February 2021, who were all treated with endovascular recanalization. We compared the multimode imaging and neurology scales between preoperative and postoperation to explore the safety and effectiveness of the treatment. Results A total of 13 patients were accept this study, including 6 cases with MCAO and 7 cases with ICAO.11 patients were successfully operated. Preoperative CTP showed that compared with that in the healthy side, The neurological deficits and functional independence rate at 30 days after operation、the cognitive function at 90 days after surgery were all improved significantly compare with preoperative. In addition, the radiographic follow-up some patients showed that no restenosis occurred in the patients with successful recanalization, and with the gradual recovery of hemodynamics, the absolute values of CBF, MTT and TTP tended to be normal. Conclusion Endovascular recanalization for LAO with impaired anterior circulation perfusion is feasible, relatively and relatively safe, improving patients’overall prognosis and quality of life. Further larger scale studies are needed to evaluate the efficacy and long-term outcome associated with this treatment.
[1] 中华医学会神经病学分会, 中华医学会神经病学分会神经血管介入协作组. 中国缺血性脑血管病非急诊介入治疗术前评估专家共识[J]. 中华内科杂志, 2020, 59(4): 277-285. [2] WANG Y, ZHAO X, LIU L, et al, Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: the Chinese Intracranial Atherosclerosis (CICAS) Study.[J]. Stroke, 2014, 45(3): 663-669. [3] REYNOLDS MR, GRUBB RL, CLARKE WR, et al.Investigating the mechanisms of perioper- ative ischemic stroke in the Carotid Occlusion Surgery Study[J]. J Neurosurg, 2013, 119(4): 988-895. [4] 中华医学会神经病学分会神经血管介入协作组, 中国医师协会神经内科医师分会神经介入专业委员会, 中国研究型医院学会介入神经病学专业委员会. 中国颅内外大动脉非急性闭塞血管内介入治疗专家共识[J]. 中华内科杂志, 2020, 59(12): 932-941 . [5] HASAN D, ZANATY M, STARKE RM, et al.Feasibility, safety, and changes in systolic blood pressure associated with endovascular revascularization of symptomatic and chronically occluded cervical internal carotid artery using a newly suggested radiographic classification of chronically occluded cervical internal carotid artery: pilot study[J]. J Neurosurg, 2018, 1: 1-10. [6] CHEN YH, LEONG WS, LIN MS, et al.Predictors for Successful Endovascular Intervention in Chronic Carotid Artery Total Occlusion[J]. JACC Cardiovasc Interv, 2016, 9(17): 1825-1832. [7] GAO F, GUO X, HAN J, et al.Endovascular recanalization for symptomatic non-acute middle cerebral artery occlusion: proposal of a new angiographic classification[J]. J Neurointerv Surg, 2021, 13(10): 900-905. [8] KANG K, YANG B, GONG X, et al.Cerebral Hemodynamic Changes After Endovascular Recanalization of Symptomatic Chronic Intracranial Artery Occlusion[J]. Front Neurol, 2020, 11: 318. [9] NOGUEIRA RG, JADHAV AP, HAUSSEN DC, et al.Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct[J]. N Engl J Med, 2018, 378(1): 11-21. [10] ALBERS GW, MARKS MP, KEMP S, et al.Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging[J]. N Engl J Med, 2018, 378(8): 708-718. [11] AGHAEBRAHIM A, JOVIN T, JADHAV AP, et al.Endovascular recanalization of complete subacute to chronic atherosclerotic occlusions of intracranial arteries. Journal of Neurointerventional Surgery[J].2014, 6(9): 645-648. [12] 李修珍, 闫文涛, 郭姗, 等. 症状性非急性大脑中动脉闭塞血管再通治疗研究[J]. 中国现代神经疾病杂志, 2020, 20(6): 512-518. [13] CHEN K, HOU X, ZHOU Z, et al.The efficacy and safety of endovascular recanalization of occluded large cerebral arteries during the subacute phase of cerebral infarction: a case series report[J]. Stroke Vasc Neurol, 2017, 2(3): 124-131. [14] FAN YL, WAN JQ, ZHOU ZW, et al.Neurocognitive improvement after carotid artery stenting in patients with chronic internal carotid artery occlusion: a prospective, controlled, single-center study[J]. Vasc Endovascular Surg, 2014, 48(4): 305-310. [15] XIONG Z, LIU C, WANG F, et al.Protective effects of breviscapine on ischemic vascular dementia in rats[J]. Biol Pharm Bull, 2006, 29(9): 1880-1885. [16] 王益, 史树贵, 陈康宁, 等. 介入再通术改善慢性闭塞性脑血管病变患者认知功能的初步研究[J]. 第三军医大学学报, 2017, 39(6): 564-567. [17] CELSIS P, AGNIEL A, CARDEBAT D, et al.Age related cognitive decline: a clinical entity? A longitudinal study of cerebral blood flow and memory performance[J]. J Neurol Neurosurg Psychiatry, 1997, 62(6): 601-608. [18] 边志杰, 刘傲飞, 刘云娥, 等. 左右颅内动脉重度狭窄或闭塞患者认知功能损害研究[J]. 中风与神经疾病杂志, 2020, 37(5): 401-405. [19] 危薇, 罗华, 汪静秋. 颈内动脉重度狭窄或闭塞患者脑血管反应性和认知功能的相关性研究[J]. 卒中与神经疾病, 2017, 24(5): 407-409+419. [20] ZHENG M, SONG Y, ZHANG J, et al.Endovascular Recanalization of Non-acute Symptomatic Middle Cerebral Artery Total Occlusion and Its Short-Term Outcomes[J]. Front Neurol, 2019, 10: 484. [21] MISHRA NK, CHRISTENSEN S, WOUTERS A, et al.Reperfusion of very low cerebral blood volume lesion predicts parenchymal hematoma after endovascular therapy[J]. Stroke, 2015, 46(5): 1245-1249. [22] DESAI SM, HAUSSEN DC, AGHAEBRAHIM A, et al.Thrombectomy 24 hours after stroke: beyond DAWN[J]. J Neurointerv Surg, 2018, 10(11): 1039-1042. [23] GONZÁLEZ RG. Clinical MRI of acute ischemic stroke[J]. J Magn Reson Imaging, 2012, 36(2): 259-271.
2023, Vol. 20 
