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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Endovascular Treatment for Symptomatic Nonacute Long-Segment ICA Occlusion: Outcomes of 2 Recanalization Techniques
Chun Zhou1, Zhen-Yu Jia1, Yue-Zhou Cao1
1From the Department of Interventional Radiology (C.Z., Z.-Y.J., Y.-Z.C., L.-B.Z., H.-B.S., S.L.), The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Background And Purpose:
For symptomatic nonacute long-segment internal carotid artery occlusion (LICAO) lesions, the endovascular treatment strategies are always complex and challenging. This study aims to analyze the effect of 2 recanalization techniques (angioplasty without distal embolic protection [AWDEP] or direct Aspiration Recanalization Combined with AngioplaSty under Intracranial Stent retriever protection [ARSIS]) on the technical success rate and clinical prognosis.
Materials And Methods:
Fifty-three patients with LICAO who underwent endovascular treatment at our center were retrospectively analyzed, including 41 (77.4%) patients in the AWDEP group and 12 (22.6%) in the ARSIS group. Patients' clinical information, radiologic characteristics, recanalization rates, perioperative complications, and follow-up outcomes were compared between the 2 groups.
Results:
Among these patients, the median interval from radiologic occlusion to recanalization was 35 days. Successful recanalization was achieved in a smaller proportion of the AWDEP group than in the ARSIS group (82.9% versus 100%, P = .29). The total number and length of implanted stents in the AWDEP group were significantly more in the ARSIS group (P = .009 and P = .007, respectively). The incidence of periprocedural complications and in-stent restenosis among patients undergoing the AWDEP technique was higher with the ARSIS technique (19.5% versus 0%, P = .23 and 26.5% versus 8.3%, P = .37, respectively). At 90-day follow-up, there was a greater trend toward better functional outcomes in the ARSIS group than in the AWDEP group (median mRS score: 0 [range, 0-1] versus 1 [range, 0-2], P = .07).
Conclusions:
Compared with the AWDEP technique, the ARSIS technique may be more beneficial for endovascular treatment of symptomatic nonacute LICAO, particularly in reducing the implanted stent burden. Prospective and multicenter studies are needed to further confirm the safety, efficacy, and durability of the ARSIS technique.
