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Parallel guidewire technique in acute ischemic stroke secondary to carotid artery dissection
Xiongjun He1, Liang Zhang1, Kaifeng Li1
1Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen, China.
Insights
Endovascular therapy (EVT) shows promising results for acute ischemic stroke (AIS) caused by carotid artery dissection (CAD). Utilizing a parallel guidewire technique in EVT can significantly reduce procedure time.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Radiology
Background:
- Acute ischemic stroke (AIS) secondary to carotid artery dissection (CAD) presents a significant clinical challenge.
- Evaluating the efficacy of endovascular therapy (EVT) in managing AIS due to CAD is crucial for improving patient outcomes.
Purpose of the Study:
- To assess the influence of EVT on AIS secondary to CAD.
- To compare the effectiveness of single versus parallel guidewire techniques in EVT for CAD patients.
Main Methods:
- A retrospective study of 17 patients with AIS secondary to CAD treated with EVT.
- Data collected included procedural success, reperfusion rates (mTICI), complications, and clinical outcomes (mRS) at three months.
- Puncture-to-reperfusion times were compared between single and parallel guidewire groups.
Main Results:
- EVT achieved a 100% procedural success rate with high rates of successful reperfusion (82.4% mTICI 3, 17.6% mTICI 2b).
- 82.3% of patients achieved good clinical outcomes (mRS 0-2) at three months.
- The parallel guidewire group demonstrated significantly shorter puncture-to-reperfusion times compared to the single guidewire group.
Conclusions:
- EVT is associated with a good prognosis for patients with AIS secondary to CAD.
- The use of a parallel guidewire technique in EVT can effectively reduce operation time.
Background:
The aim of the study was to evaluate the influence of endovascular therapy (EVT) on the acute ischemic stroke (AIS) secondary to carotid artery dissection (CAD).
Methods:
This single-center retrospective study enrolled 17 patients admitted with AIS secondary to CAD from January 2018 to November 2019 in the Department of Neurology, Shenzhen Hospital of Southern Medical University where patients received EVT with guidewire or parallel guidewire. Outcomes including postoperative complications were recorded, the prognostic factors of patients were explored, and the effectiveness of single guidewire versus parallel guidewire on EVT was compared.
Results:
Before treatment, the mean National Institute of Health stroke scale (NIHSS) was 14.4 in 10 cases (58.8%) of CAD complicated with intracranial artery embolism. All patients underwent EVT, and the success rate of operation was 100%. After all interventions, modified thrombolysis in cerebral ischemia (mTICI) 3 reperfusion was achieved in 14 patients (82.4%), and mTICI 2b reperfusion was achieved in 3 (17.6%). One patient had cerebral infarction and edema complicated with cerebral hernia, one patient had cerebral hemorrhage, one patient had complicated subarachnoid hemorrhage, and five cases had asymptomatic cerebral hemorrhage. Three months after treatment, 14 cases (82.3%) achieved a good clinical outcome (modified Rankin scale, mRS: 0-2). Puncture-to-reperfusion time in the parallel guidewire group was significantly shorter than that of the single guidewire group. However, the differences in NIHSS score, postoperative mTICI, and mRS score between both groups did not reach significance.
Conclusions:
CAD patients receiving EVT have a good prognosis, and application of a parallel guidewire can reduce operation time.
