Abstract
Purpose
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).
Methods
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.
Results
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.
Conclusion
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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Funding
The study was funded by the National Natural Science Foundation of China (81701287, 81620108011), the Beijing Municipal Administration of Hospitals’ Mission Plan (SML 20150802) and the National Key R&D Program of China (2017YFC1308401).
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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Wu, C., Chang, W., Wu, D. et al. Angioplasty and/or stenting after thrombectomy in patients with underlying intracranial atherosclerotic stenosis. Neuroradiology 61, 1073–1081 (2019). https://doi.org/10.1007/s00234-019-02262-5
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DOI: https://doi.org/10.1007/s00234-019-02262-5