Fabio Settecase, James Caldwell, Mubashir Pervez, Omar Kass-Hout, Warren T Kim, Rajkamal S Khangura, Matthew D Alexander, Amanda Baker, Nathan Farkas, Peter J Pema, Tom Pearson, Shane S Lee, Matthew J Page, Ben McGuinness, Ashish A Gajjar, JaeHyun Kim, Matheus Antoniazzi Dabus, Joey D English, Guilherme Dabus
{"title":"丹增术治疗伴有颅内动脉粥样硬化性疾病的急性缺血性脑卒中。","authors":"Fabio Settecase, James Caldwell, Mubashir Pervez, Omar Kass-Hout, Warren T Kim, Rajkamal S Khangura, Matthew D Alexander, Amanda Baker, Nathan Farkas, Peter J Pema, Tom Pearson, Shane S Lee, Matthew J Page, Ben McGuinness, Ashish A Gajjar, JaeHyun Kim, Matheus Antoniazzi Dabus, Joey D English, Guilherme Dabus","doi":"10.1136/jnis-2025-023663","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Catheter-mediated (Dotter) angioplasty has been previously described for extracranial/peripheral arteries. Tenzing (Route 92 Medical, San Mateo, California, USA), a shelf-reducing delivery catheter, has an atraumatic tapered distal tip that progressively enlarges to maximal outer diameter of 1.2 mm (Tenzing 5), 1.6 mm (Tenzing 7), and 2.1 mm (Tenzing 8).</p><p><strong>Objective: </strong>To report our initial experience treating acutely symptomatic intracranial atherosclerotic disease (ICAD) using Dotter angioplasty with Tenzing (Tenzingplasty).</p><p><strong>Methods: </strong>After institutional review board approvals, we retrospectively reviewed clinical and procedural data of patients with underlying ICAD treated with off-label Tenzingplasty between 2022 and 2025, either as part of endovascular treatment for large vessel occlusion, or after medical therapy failure <96 hours from presentation.</p><p><strong>Results: </strong>We identified 53 consecutive patients with symptomatic ICAD who underwent Tenzingplasty, median (IQR) age 63 (57-70) years, 29 (55%) male. ICAD locations were: M1 (24), M2 (9), internal carotid artery (3), vertebral V4 segment (7), basilar (8), vertebrobasilar junction (1), and A2 anterior cerebral artery (1). First pass aspiration thrombectomy for patients with an initial modified Thrombolysis in Cerebral Infarction score 0 (without crossing the ICAD lesion) was performed in 34/53 (64%). After median 1 (IQR 1-2) Tenzingplasty pass, median (IQR) stenosis improved from 100% (95-100) to 60% (42-76) post-Tenzingplasty (P<0.0001). Subsequent balloon angioplasty or stenting was performed in 4% and 21%, respectively. Successful final reperfusion (expanded Thrombolysis in Cerebral Infarction 2b-3) was achieved in 81%, with one Tenzingplasty-related complication (a non-flow limiting dissection), and no perforations. In follow up, 25/44 (57%) had a 90-day modified Rankin Scale score of 0-2.</p><p><strong>Conclusion: </strong>Tenzingplasty may be a feasible and safe rescue therapy for improving luminal caliber, flow restoration, and/or lesion preparation for stenting in acutely symptomatic ICAD.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3000,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Intracranial Dotter angioplasty using Tenzing (Tenzingplasty) for acute ischemic stroke with underlying intracranial atherosclerotic disease.\",\"authors\":\"Fabio Settecase, James Caldwell, Mubashir Pervez, Omar Kass-Hout, Warren T Kim, Rajkamal S Khangura, Matthew D Alexander, Amanda Baker, Nathan Farkas, Peter J Pema, Tom Pearson, Shane S Lee, Matthew J Page, Ben McGuinness, Ashish A Gajjar, JaeHyun Kim, Matheus Antoniazzi Dabus, Joey D English, Guilherme Dabus\",\"doi\":\"10.1136/jnis-2025-023663\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Catheter-mediated (Dotter) angioplasty has been previously described for extracranial/peripheral arteries. Tenzing (Route 92 Medical, San Mateo, California, USA), a shelf-reducing delivery catheter, has an atraumatic tapered distal tip that progressively enlarges to maximal outer diameter of 1.2 mm (Tenzing 5), 1.6 mm (Tenzing 7), and 2.1 mm (Tenzing 8).</p><p><strong>Objective: </strong>To report our initial experience treating acutely symptomatic intracranial atherosclerotic disease (ICAD) using Dotter angioplasty with Tenzing (Tenzingplasty).</p><p><strong>Methods: </strong>After institutional review board approvals, we retrospectively reviewed clinical and procedural data of patients with underlying ICAD treated with off-label Tenzingplasty between 2022 and 2025, either as part of endovascular treatment for large vessel occlusion, or after medical therapy failure <96 hours from presentation.</p><p><strong>Results: </strong>We identified 53 consecutive patients with symptomatic ICAD who underwent Tenzingplasty, median (IQR) age 63 (57-70) years, 29 (55%) male. ICAD locations were: M1 (24), M2 (9), internal carotid artery (3), vertebral V4 segment (7), basilar (8), vertebrobasilar junction (1), and A2 anterior cerebral artery (1). First pass aspiration thrombectomy for patients with an initial modified Thrombolysis in Cerebral Infarction score 0 (without crossing the ICAD lesion) was performed in 34/53 (64%). After median 1 (IQR 1-2) Tenzingplasty pass, median (IQR) stenosis improved from 100% (95-100) to 60% (42-76) post-Tenzingplasty (P<0.0001). Subsequent balloon angioplasty or stenting was performed in 4% and 21%, respectively. Successful final reperfusion (expanded Thrombolysis in Cerebral Infarction 2b-3) was achieved in 81%, with one Tenzingplasty-related complication (a non-flow limiting dissection), and no perforations. 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引用次数: 0
摘要
导言：导管介导（Dotter）血管成形术先前已被用于颅外/外周动脉。Tenzing （Route 92 Medical, San Mateo, California， USA）是一种减少置管架的导管，具有非创伤性锥形远端尖端，逐渐扩大到最大外径1.2 mm (Tenzing 5), 1.6 mm （Tenzing 7）和2.1 mm （Tenzing 8）。目的：报告丹增血管成形术治疗急性症状性颅内动脉粥样硬化病（ICAD）的初步经验。方法：在机构审查委员会批准后，我们回顾性回顾了2022年至2025年期间，作为大血管闭塞血管内治疗的一部分，或在药物治疗失败后，经标签外Tenzingplasty治疗的潜在ICAD患者的临床和手术资料。结果：我们确定了53例连续接受Tenzingplasty治疗的症状性ICAD患者，中位（IQR）年龄63（57-70）岁，男性29（55%）。ICAD部位为：M1（24）、M2(9)、颈内动脉(3)、椎体V4节段(7)、基底动脉(8)、椎基底动脉交界处(1)、大脑A2前动脉(1)。对于初始改良溶栓评分为0分（未穿过ICAD病变）的脑梗死患者，有34/53（64%）进行了第一次吸入性取栓。在中位1 (IQR 1-2) Tenzingplasty通过后，中位（IQR）狭窄从100%（95-100）改善到60%（42-76）。结论：在急性症状性ICAD中，Tenzingplasty可能是一种可行且安全的挽救治疗，可以改善管径、恢复血流和/或为支架植入做病变准备。
Intracranial Dotter angioplasty using Tenzing (Tenzingplasty) for acute ischemic stroke with underlying intracranial atherosclerotic disease.
Introduction: Catheter-mediated (Dotter) angioplasty has been previously described for extracranial/peripheral arteries. Tenzing (Route 92 Medical, San Mateo, California, USA), a shelf-reducing delivery catheter, has an atraumatic tapered distal tip that progressively enlarges to maximal outer diameter of 1.2 mm (Tenzing 5), 1.6 mm (Tenzing 7), and 2.1 mm (Tenzing 8).
Objective: To report our initial experience treating acutely symptomatic intracranial atherosclerotic disease (ICAD) using Dotter angioplasty with Tenzing (Tenzingplasty).
Methods: After institutional review board approvals, we retrospectively reviewed clinical and procedural data of patients with underlying ICAD treated with off-label Tenzingplasty between 2022 and 2025, either as part of endovascular treatment for large vessel occlusion, or after medical therapy failure <96 hours from presentation.
Results: We identified 53 consecutive patients with symptomatic ICAD who underwent Tenzingplasty, median (IQR) age 63 (57-70) years, 29 (55%) male. ICAD locations were: M1 (24), M2 (9), internal carotid artery (3), vertebral V4 segment (7), basilar (8), vertebrobasilar junction (1), and A2 anterior cerebral artery (1). First pass aspiration thrombectomy for patients with an initial modified Thrombolysis in Cerebral Infarction score 0 (without crossing the ICAD lesion) was performed in 34/53 (64%). After median 1 (IQR 1-2) Tenzingplasty pass, median (IQR) stenosis improved from 100% (95-100) to 60% (42-76) post-Tenzingplasty (P<0.0001). Subsequent balloon angioplasty or stenting was performed in 4% and 21%, respectively. Successful final reperfusion (expanded Thrombolysis in Cerebral Infarction 2b-3) was achieved in 81%, with one Tenzingplasty-related complication (a non-flow limiting dissection), and no perforations. In follow up, 25/44 (57%) had a 90-day modified Rankin Scale score of 0-2.
Conclusion: Tenzingplasty may be a feasible and safe rescue therapy for improving luminal caliber, flow restoration, and/or lesion preparation for stenting in acutely symptomatic ICAD.
期刊介绍：
The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.
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