Technical effectiveness and safety of emergent stenting in patients with acute ischemic stroke and carotid near-occlusion.

IF 2.6 3区医学 Q2 CLINICAL NEUROLOGY

Neuroradiology Pub Date : 2025-09-30 DOI:10.1007/s00234-025-03784-x

Andrés García Pastor, Isabel Lera Ramírez, Alejandro Bonilla Tena, David Seoane, Patricia Calleja, Fernando Ostos, Elena De Celis-Ruiz, Carlos Gómez Escalonilla, Patricia Simal, Alfonso López-Frías López-Jurado, Daniel Perez Gil, Rocío Vera Lechuga, Cristina Moreno-López, Jose Carlos Fernandez-Ferro, María Teresa Montalvo Moraleda, Javier Roa Escobar, Araceli García Torres, Inmaculada Navas Vinagre, Eduardo Escolar Escamilla, Rodrigo Terrero Carpio, Guillermo Martín Ávila, Ana María Iglesias Mohedano, Marta Vales Montero, Antonio Gil Núñez

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引用次数: 0

Abstract

Background: The increased very early risk (within the first 2 days after presenting event) of recurrent stroke among patients with symptomatic carotid near-occlusion (SCNO) and full collapse (FC) might justify ultra-early carotid revascularization of these patients. However, we lack data about technical effectiveness and safety of this approach in SCNO. This study aims to assess the feasibility and safety of emergent carotid stenting (eCAS) in patients with SCNO.

Methods: Multicenter study including patients with acute stroke and extracranial carotid stenosis or occlusion undergoing mechanical thrombectomy and eCAS. The main outcomes were revascularization failure (incomplete carotid revascularization/occlusion at 48h), intracerebral hemorrhage (ICH) and symptomatic ICH (sICH). Patients with SCNO with and without FC were compared with the remaining patients.

Results: 309 patients were included, 215 (69.6%) males, mean age (SD) 67.2 (12.8). 45 patients had SCNO and 16 SCNO + FC. Revascularization failure occurred in 15.6% of SCNO and in 13.4% of the remaining patients (p = 0.826), with no differences between SCNO with or without FC. ICH was more common in patients with SCNO (42% for all SCNO, 47% for SCNO + FC, and 24% for the remaining patients; p = 0.027). This increased risk of ICH associated with SCNO persisted in the multivariate analysis (OR 3.49 [95%CI 1.63 - 7.48], p = 0.001). No significant differences in the rate of sICH were observed between SCNO and the remaining patients.

Conclusions: The use of eCAS in acute SCNO seems to be feasible. However, the safety of the procedure is uncertain, as it could be associated with an increased risk of ICH.

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急性缺血性脑卒中伴颈动脉近闭塞患者急诊支架置入的技术有效性和安全性。

背景：在症状性颈动脉近闭塞（SCNO）和完全塌陷（FC）患者中，复发性卒中的极早期风险（出现事件后的前2天内）增加，可能证明这些患者超早期颈动脉血运重建术是合理的。然而，我们缺乏关于该方法在SCNO中的技术有效性和安全性的数据。本研究旨在评估SCNO患者急诊颈动脉支架植入术（eCAS）的可行性和安全性。方法：采用多中心研究，纳入急性脑卒中合并颅外颈动脉狭窄或闭塞的机械取栓和eCAS患者。主要结局为血运重建失败（颈动脉不完全血运重建/ 48小时闭塞）、脑出血（ICH）和症状性脑出血（siich）。将伴有和不伴有FC的SCNO患者与其余患者进行比较。结果：纳入309例患者，其中男性215例（69.6%），平均年龄（SD） 67.2（12.8）。SCNO 45例，SCNO + FC 16例。15.6%的SCNO和13.4%的其余患者发生血运重建失败（p = 0.826）， SCNO合并或不合并FC之间无差异。脑出血在SCNO患者中更为常见（所有SCNO患者为42%，SCNO + FC患者为47%，其余患者为24%；p = 0.027）。在多变量分析中，脑出血与SCNO相关的风险增加持续存在（OR 3.49 [95%CI 1.63 - 7.48], p = 0.001）。在SCNO和其他患者之间没有观察到siich发生率的显著差异。结论：应用eCAS治疗急性SCNO是可行的。然而，该手术的安全性是不确定的，因为它可能与脑出血风险增加有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neuroradiology 医学-核医学

CiteScore

5.30

自引率

3.60%

发文量

214

审稿时长

4-8 weeks

期刊介绍： Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.