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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Endovascular re-canalization for symptomatic non-acute intracranial large artery occlusion: a single-center
Wenbao Liang1,2,3, Jiaqi Yin4, Chenyu Lu3
1Department of Neurology, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
Insights
Endovascular recanalization is safe and effective for symptomatic non-acute intracranial large artery occlusion (SNA-ILAO). This procedure achieved successful reperfusion in all patients, with low rates of complications and re-stenosis.
Area of Science:
- Neurology
- Interventional Radiology
- Vascular Surgery
Background:
- Symptomatic non-acute intracranial large artery occlusion (SNA-ILAO) presents significant management challenges.
- Patients with SNA-ILAO face high risks of morbidity and recurrent ischemic events despite standard medical therapy.
- This patient subgroup necessitates specialized treatment approaches.
Purpose of the Study:
- To evaluate the feasibility of endovascular interventional recanalization for SNA-ILAO.
- To assess the safety of endovascular interventional recanalization for SNA-ILAO.
Main Methods:
- Retrospective data collection from 2018-2021 at the Fourth Affiliated Hospital of Xinjiang Medical University.
- Inclusion of patients with SNA-ILAO who underwent endovascular interventional therapy.
- Analysis of clinical demography, imaging, treatment details, prognosis, and follow-up imaging.
Main Results:
- All 24 enrolled patients achieved successful recanalization.
- 87.5% achieved TICI 3 reperfusion, and 12.5% achieved TICI 2b reperfusion.
- Low rates of asymptomatic intracranial hemorrhage (8.3%) and re-stenosis (12.5%) were observed, with no 30-day recurrent ischemic events.
Conclusions:
- Endovascular recanalization demonstrates potential safety and efficacy in treating SNA-ILAO.
- A non-negligible complication rate necessitates careful procedural execution and strict controls.
- This intervention offers a viable option for managing SNA-ILAO patients.
Background:
Managing patients with symptomatic non-acute intracranial large artery occlusion (SNA-ILAO) poses a significant challenge due to the high morbidity and risk of recurrent critical ischemic events, even with standard medical therapy. This unique subgroup of patients requires specialized attention. The aim of this study is to evaluate the feasibility and safety of endovascular interventional recanalization for SNA-ILAO.
Methods:
We retrospectively collected data of patients with SNA-ILAO who underwent endovascular interventional therapy at the Fourth Affiliated Hospital of Xinjiang Medical University from 2018 to 2021. The collected data included clinical demography, imaging data, treatment details, and prognosis. Follow-up imaging assessments were conducted for the patients, and descriptive statistics were performed.
Results:
A total of 24 patients were enrolled, with a majority being male (58.3%) and a mean age of 62.0±9.3 years. The pre-treatment median modified Rankin scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS) scores at baseline were 3 and 1, respectively. The most common occlusion location was the middle cerebral artery (MCA), including M1 (70.8%), M2 (20.8%), and M3 (4.7%). Successful recanalization was achieved in all 24 patients, with 21 cases (87.5%) achieving thrombolysis in cerebral infarction (TICI) 3 reperfusion and the remaining 3 cases (12.5%) achieving TICI 2b reperfusion. Asymptomatic intracranial hemorrhage (ICH) occurred in 2 patients (8.3%). During the first 30-day clinical follow-up, none of these patients experienced any recurrent cerebral ischemic events. During the 29.5-month follow-up period for vessel imaging, only 12.5% (3/24) of patients who had follow-up imaging experienced re-stenosis.
Conclusions:
Endovascular recanalization is a potentially safe and effective procedure for patients with SNA-ILAO. However, it is important to note that there is still a non-negligible rate of complications associated with this treatment. Therefore, exercising caution and implementing strict controls when administering this procedure is crucial.
