Yang Yang, Xiaoya Wang, Jialiang Lu, Ye Li, Lili Zhao, Yating Jian, Tao Li, Meijuan Dang, Ziwei Lu, Fangcun Li, Fan Tang, Qingyu Fan, Ning Bu, Huqing Wang, Ru Zhang, An Wen, Guilian Zhang, Hong Fan, Lei Zhang
{"title":"症状性颅内动脉粥样硬化性狭窄血管内治疗的最佳时机：一项真实世界单中心研究。","authors":"Yang Yang, Xiaoya Wang, Jialiang Lu, Ye Li, Lili Zhao, Yating Jian, Tao Li, Meijuan Dang, Ziwei Lu, Fangcun Li, Fan Tang, Qingyu Fan, Ning Bu, Huqing Wang, Ru Zhang, An Wen, Guilian Zhang, Hong Fan, Lei Zhang","doi":"10.3389/fneur.2026.1749046","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To determine the optimal timing of endovascular treatment for acute cerebral infarction with symptomatic intracranial atherosclerotic stenosis (sICAS) in real world practice.</p><p><strong>Methods: </strong>This retrospective single center study enrolled consecutive sICAS patients undergoing intervention. According to the interval from symptom onset to intervention, patients were divided into early (≤14 days) and delayed (>14 days) intervention groups. Primary outcomes were any stroke or death within 30 days and the 90-day mRS score. Secondary analyses explored factors influencing surgical timing.</p><p><strong>Results: </strong>Among 211 eligible patients, 174 were analyzed, including 53 patients in the early intervention group and 121 patients in the delayed intervention group. The 30-day stroke or death rates were 11.3 and 8.3%, and unfavorable 90-day outcomes were 18.9 and 10.7% in the early and delayed groups (<i>p</i> = 0.521, 0.145). Higher preoperative NIHSS, higher albumin-to-globulin ratio, and higher LDL might be independent factors influencing the doctors' decision on the timing of the intervention (OR = 0.819, 0.149, 0.394; <i>p</i> = 0.027, 0.042, 0.004). Thresholds favoring early intervention were NIHSS ≤ 3, albumin-to-globulin ratio < 1.53, and LDL < 2.85 mmol/L (AUC = 0.664, 0.603, 0.642; <i>p</i> = 0.001, 0.030, 0.003). For posterior circulation lesions, early intervention might led to more unfavorable outcomes than delayed intervention (29.2% vs. 8.2%, <i>p</i> = 0.033).</p><p><strong>Conclusion: </strong>In anterior circulation sICAS with minor stroke (NIHSS ≤ 3), high Alberta stroke program early CT score (ASPECTS)/posterior circulation ASPECTS (pcASPECTS) (8-9), and well-controlled LDL, intervention timing may not be restricted, whereas Basilar artery (BA) lesions appear better suited for delayed intervention. Multiple parallel severe stenoses, severe pre-existing global brain injury, and plaque high-signal intensity did not influence on the surgical timing. The conclusions of this study should be validated in future prospective studies.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1749046"},"PeriodicalIF":2.8000,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143744/pdf/","citationCount":"0","resultStr":"{\"title\":\"Optimal timing of endovascular treatment for symptomatic intracranial atherosclerotic stenosis: a real world single center study.\",\"authors\":\"Yang Yang, Xiaoya Wang, Jialiang Lu, Ye Li, Lili Zhao, Yating Jian, Tao Li, Meijuan Dang, Ziwei Lu, Fangcun Li, Fan Tang, Qingyu Fan, Ning Bu, Huqing Wang, Ru Zhang, An Wen, Guilian Zhang, Hong Fan, Lei Zhang\",\"doi\":\"10.3389/fneur.2026.1749046\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To determine the optimal timing of endovascular treatment for acute cerebral infarction with symptomatic intracranial atherosclerotic stenosis (sICAS) in real world practice.</p><p><strong>Methods: </strong>This retrospective single center study enrolled consecutive sICAS patients undergoing intervention. According to the interval from symptom onset to intervention, patients were divided into early (≤14 days) and delayed (>14 days) intervention groups. Primary outcomes were any stroke or death within 30 days and the 90-day mRS score. Secondary analyses explored factors influencing surgical timing.</p><p><strong>Results: </strong>Among 211 eligible patients, 174 were analyzed, including 53 patients in the early intervention group and 121 patients in the delayed intervention group. The 30-day stroke or death rates were 11.3 and 8.3%, and unfavorable 90-day outcomes were 18.9 and 10.7% in the early and delayed groups (<i>p</i> = 0.521, 0.145). Higher preoperative NIHSS, higher albumin-to-globulin ratio, and higher LDL might be independent factors influencing the doctors' decision on the timing of the intervention (OR = 0.819, 0.149, 0.394; <i>p</i> = 0.027, 0.042, 0.004). Thresholds favoring early intervention were NIHSS ≤ 3, albumin-to-globulin ratio < 1.53, and LDL < 2.85 mmol/L (AUC = 0.664, 0.603, 0.642; <i>p</i> = 0.001, 0.030, 0.003). For posterior circulation lesions, early intervention might led to more unfavorable outcomes than delayed intervention (29.2% vs. 8.2%, <i>p</i> = 0.033).</p><p><strong>Conclusion: </strong>In anterior circulation sICAS with minor stroke (NIHSS ≤ 3), high Alberta stroke program early CT score (ASPECTS)/posterior circulation ASPECTS (pcASPECTS) (8-9), and well-controlled LDL, intervention timing may not be restricted, whereas Basilar artery (BA) lesions appear better suited for delayed intervention. Multiple parallel severe stenoses, severe pre-existing global brain injury, and plaque high-signal intensity did not influence on the surgical timing. The conclusions of this study should be validated in future prospective studies.</p>\",\"PeriodicalId\":12575,\"journal\":{\"name\":\"Frontiers in Neurology\",\"volume\":\"17 \",\"pages\":\"1749046\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2026-04-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143744/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Frontiers in Neurology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3389/fneur.2026.1749046\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2026/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fneur.2026.1749046","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Optimal timing of endovascular treatment for symptomatic intracranial atherosclerotic stenosis: a real world single center study.
Objective: To determine the optimal timing of endovascular treatment for acute cerebral infarction with symptomatic intracranial atherosclerotic stenosis (sICAS) in real world practice.
Methods: This retrospective single center study enrolled consecutive sICAS patients undergoing intervention. According to the interval from symptom onset to intervention, patients were divided into early (≤14 days) and delayed (>14 days) intervention groups. Primary outcomes were any stroke or death within 30 days and the 90-day mRS score. Secondary analyses explored factors influencing surgical timing.
Results: Among 211 eligible patients, 174 were analyzed, including 53 patients in the early intervention group and 121 patients in the delayed intervention group. The 30-day stroke or death rates were 11.3 and 8.3%, and unfavorable 90-day outcomes were 18.9 and 10.7% in the early and delayed groups (p = 0.521, 0.145). Higher preoperative NIHSS, higher albumin-to-globulin ratio, and higher LDL might be independent factors influencing the doctors' decision on the timing of the intervention (OR = 0.819, 0.149, 0.394; p = 0.027, 0.042, 0.004). Thresholds favoring early intervention were NIHSS ≤ 3, albumin-to-globulin ratio < 1.53, and LDL < 2.85 mmol/L (AUC = 0.664, 0.603, 0.642; p = 0.001, 0.030, 0.003). For posterior circulation lesions, early intervention might led to more unfavorable outcomes than delayed intervention (29.2% vs. 8.2%, p = 0.033).
Conclusion: In anterior circulation sICAS with minor stroke (NIHSS ≤ 3), high Alberta stroke program early CT score (ASPECTS)/posterior circulation ASPECTS (pcASPECTS) (8-9), and well-controlled LDL, intervention timing may not be restricted, whereas Basilar artery (BA) lesions appear better suited for delayed intervention. Multiple parallel severe stenoses, severe pre-existing global brain injury, and plaque high-signal intensity did not influence on the surgical timing. The conclusions of this study should be validated in future prospective studies.
期刊介绍：
The section Stroke aims to quickly and accurately publish important experimental, translational and clinical studies, and reviews that contribute to the knowledge of stroke, its causes, manifestations, diagnosis, and management.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
