改良微导管首过效应：提高急性缺血性脑卒中ICAS的诊断准确性和治疗策略

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-05-08 DOI:10.1016/j.jocn.2025.111309

Rundong Chen , Weilong Hua , Yilei Zhang , Zifu Li , Hongjian Zhang , Yongwei Zhang , Pengfei Yang , Lei Zhang , Jianmin Liu

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引用次数: 0

摘要

目的评价改良微导管首过效应对AIS血管内治疗（EVT）中icas相关闭塞治疗决策的指导作用。方法本研究分析了2023年7月至2024年1月收集的OCEAN-AIS-EVT REGISTRY中31例改良微导管首次通过效应阳性的AIS患者的数据。我们评估了诊断的准确性、手术效率、再通率和安全性。结果所有病例均确诊为icas。中位年龄69岁，男性占61.29%。NIHSS评分中位数为9分，ASPECTS评分为9分。狭窄主要发生在大脑中动脉M1段（74.19%）。穿刺至再通的中位时间为18.92分钟。87.10%的病例成功再通（eTICI 3级）。术后出血占12.90%，有症状性出血占3.23%。在90天的随访中，80.64%的患者mRS评分为0-2。结论改良微导管首过效应可作为指导icas相关AIS EVT策略的初步工具。通过确认远端血管通畅，无需事先取栓即可直接成形术，简化了手术过程，减少了机械操作。虽然这种探索性方法已经显示出提高治疗效率和改善临床结果的潜力，但需要更大规模的前瞻性研究来进一步验证这些初步发现。

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Modified microcatheter first-pass effect: Enhancing diagnostic accuracy and treatment strategies for ICAS in acute ischemic stroke

Objectives

To evaluate the effectiveness of the modified microcatheter first-pass effect in guiding treatment decisions for ICAS-related occlusions during endovascular therapy (EVT) for AIS.

Methods

This study analyzed data from 31 AIS patients with a positive modified microcatheter first-pass effect from the OCEAN-AIS-EVT REGISTRY collected between July 2023 and January 2024. We evaluated diagnostic accuracy, procedural efficiency, recanalization rates, and safety.

Results

ICAS was confirmed in all cases. The median age was 69 years, with 61.29 % males. The median NIHSS score was 9, and ASPECTS was 9. Stenosis primarily occurred in the M1 segment of the middle cerebral artery (74.19 %). The median puncture-to-recanalization time was 18.92 min. Successful recanalization (eTICI grade 3) was achieved in 87.10 % of cases. Post-procedural hemorrhage occurred in 12.90 % of patients, with symptomatic hemorrhage in 3.23 %. At 90-day follow-up, 80.64 % had an mRS score of 0–2.

Conclusion

The modified microcatheter first-pass effect may serve as a promising preliminary tool for guiding EVT strategy in ICAS-related AIS. By confirming distal vessel patency, it enables direct angioplasty without prior thrombectomy, simplifying the procedure and reducing mechanical manipulation. While this exploratory approach has shown potential to enhance treatment efficiency and improve clinical outcomes, larger-scale prospective studies are needed to further validate these preliminary findings.

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.