Endovascular Treatment of ICAS Patients: Targeting Reperfusion Rather than Residual Stenosis
Tingyu Yi1, Alai Zhan2, Yanmin Wu1
1Cerebrovascular and Neuro-Intervention Department, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China.
Insights
Reperfusion status, not residual stenosis, is key to preventing artery reocclusion after endovascular therapy for acute ischemic stroke. Successful reperfusion significantly reduces reocclusion risk, even with severe stenosis.
Area of Science:
- Neurology
- Interventional Radiology
- Vascular Medicine
Background:
- Acute reocclusion after endovascular therapy for stroke has been linked to residual stenosis.
- However, recent observations suggest reperfusion status may be a more critical factor.
Purpose of the Study:
- To determine whether reperfusion status or residual stenosis severity is more strongly associated with artery reocclusion after endovascular treatment.
- To clarify the predictors of acute reocclusion in patients undergoing endovascular therapy for middle cerebral artery atherosclerotic occlusions.
Main Methods:
- Retrospective analysis of 86 acute ischemic stroke patients with middle cerebral artery atherosclerotic occlusions treated with endovascular therapy.
- Primary outcomes assessed: intraprocedural reocclusion during treatment and delayed reocclusion on follow-up angiography.
Main Results:
- Intraprocedural reocclusion occurred in 7.0% and delayed reocclusion in 2.3% of patients.
- Successful reperfusion was associated with significantly lower intraprocedural reocclusion rates compared to unsuccessful reperfusion, irrespective of stenosis severity.
- No significant difference in delayed reocclusion rates was observed between severe and mild-to-moderate residual stenosis groups.
Conclusions:
- Reperfusion status, rather than residual stenosis severity, is the primary determinant of artery reocclusion post-endovascular treatment.
- Achieving successful reperfusion is crucial for minimizing reocclusion risk in middle cerebral artery atherosclerosis stroke patients, even with significant residual stenosis.
Background And Purpose:
Previous studies showed that acute reocclusion after endovascular therapy is related to residual stenosis. However, we observed that reperfusion status but not residual stenosis severity is related to acute reocclusion. This study aimed to assess which factor mention above is more likely to be associated with artery reocclusion after endovascular treatment.
Methods:
This study included 86 acute ischemic stroke patients who had middle cerebral artery (MCA) atherosclerotic occlusions and received endovascular treatment within 24 h of a stroke. The primary outcomes included intraprocedural reocclusion assessed during endovascular treatment and delayed reocclusion assessed through follow-up angiography.
Results:
Of the 86 patients, the intraprocedural reocclusion rate was 7.0% (6/86) and the delayed reocclusion rate was 2.3% (2/86). Regarding intraprocedural occlusion, for patients with severe residual stenosis, patients with successful thrombectomy reperfusion showed a significantly lower rate than unsuccessful thrombectomy reperfusion (0/30 vs. 6/31, p = 0.003); on the other hand, for patients with successful thrombectomy reperfusion, patients with severe residual stenosis showed no difference from those with mild to moderate residual stenosis in terms of intraprocedural occlusion (0/30 vs. 0/25, p = 1.00). In addition, after endovascular treatment, all patients achieved successful reperfusion. There was no significant difference in the delayed reocclusion rate between patients with severe residual stenosis and those with mild to moderate residual stenosis (2/25 vs. 0/61, p = 0.085).
Conclusion:
Reperfusion status rather than residual stenosis severity is associated with artery reocclusion after endovascular treatment. Once successful reperfusion was achieved, the reocclusion occurrence was fairly low in MCA atherosclerosis stroke patients, even with severe residual stenosis.
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