Factors analysis on success rate of endovascular recanalization for non-acute long segmental internal carotid artery occlusion / 中华放射学杂志

Objective:To investigate the risk factors related to successful endovascular recanalization for non-acute long segmental occlusion of internal carotid artery and propose a strategy for selecting proper candidates for such procedure.Methods:From January 2018 to October 2022, 120 consecutive patients with non-acute long segmental internal carotid artery occlusion received the first intended endovascular recanalization treatment in the First Affiliated Hospital of Zhengzhou University. Potential variables including epidemiology, symptomatology, angiographic morphology and interventional techniques were retrospectively analyzed. Univariate and multivariate logistic regression analyses were made to investigate the independent risk factors for successful recanalization. Four types were divided according to the existence of tapered stump and ophthalmic artery flow reversion based on DSA images: A: tapered stump (-), ophthalmic artery flow reversion (-); B: tapered stump (-), ophthalmic artery flow reversion (+); C: tapered stump (+), ophthalmic artery reversion (-); D: tapered stump (+), ophthalmic artery (+). Investigation of the relationship between procedure success rate and group dividing was performed.Results:Totally 120 patients were all included. The technical success rate was 75.83% (91/120). The periprocedural complication rate was 9.17% (11/120), including 4 (3.33%) intracranial hemorrhagic events, 1 (0.83%) ischemic stroke event, 1 (0.83%) microcatheter perforation, 3 (2.75%) cavernous carotid fistulas, 2 (1.67%) iatrogenic dissections. None of these complications led to severe neurological damage or death. Through multivariate logistic regression, tapered stump (OR=4.10, 95%CI 1.19-14.16), retrograde filling of ophthalmic artery (OR=3.16, 95%CI 1.13-8.88), only cervical segment occlusion of internal carotid artery (OR=10.78, 95%CI 2.08-55.74) were the independent risk factors associated with higher technical success rate. All cases were divided into A-D four types considering the tapered stump and reversed ophthalmic flow existing or not. Technical success rates in A-D types were 30.00% (3/10), 66.67% (8/12), 70.00% (28/40), 89.66% (52/58) respectively, and the complication rates of the four types were 10.00% (1/10), 8.33% (1/12), 17.50% (7/40), 3.45% (2/58). Multivariate logistic regression showed group pattern was the independent factor on technical success rate (OR=3.72, 95%CI 1.42-9.77).Conclusions:Tapered stump, reversed ophthalmic artery flow and pure extracranial artery occlusion are the independent factors for technical success rate. Group pattern which covered the tapered stump and reversed ophthalmic artery flow is also related to technical success rate. However, the results need further confirmation with the prospective trial and a larger sample.

Analysis of risk factors of Budd-Chiari syndrome associated with hepatocellular carcinoma in patients who underwent endovascular recanalization / 中华肝胆外科杂志

Objective:To study the risk factors of Budd-Chiari syndrome (BCS) associated with hepatocellular carcinoma in patients who underwent endovascular recanalization.Methods:The data of 340 patients with BCS who underwent endovascular recanalization at the Affiliated Hospital of Xuzhou Medical University between January 2015 and June 2021 were retrospectively collected. Using propensity score matching, a total of 57 patients (40 males and 17 females) were enrolled into this study, with the age of (50.4±8.7) years. Patients were divided into the hepatocellular carcinoma group ( n=19) and the control group ( n=38) according to whether occurrence of hepatocellular carcinoma after cardovascular recanalization. Preoperative indicators including gender, age, BCS type, and model for end-stage liver disease (MELD) score, and postoperative indicators including alpha fetoprotein, intrahepatic nodule formation, vascular restenosis, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were compared between the two groups after propensity score matching. Multivariate logistic regression analysis was used to analyze the risk factors of BCS associated with after endovascular recanalization in these patients. Results:There were no significant differences in gender, age, BCS type, MELD score and other preoperative data between the two groups (all P>0.05). The proportions of patients with postoperative alpha fetoprotein>9.0 μg/L, AST>40 U/L, ALT>50 U/L, intrahepatic nodules and vascular restenosis after endovascular treatment in the hepatocellular carcinoma group were significantly higher than those in the control group (all P<0.05). Multivariate analysis showed postoperative alpha fetoprotein >9.0 μg/L ( OR=46.778, 95% CI: 3.310-661.140), AST>40 U/L ( OR=36.307, 95% CI: 1.317-1 001.009), intrahepatic nodule formation ( OR=66.254, 95% CI: 4.225-1 038.974) and vascular restenosis ( OR=16.276, 95% CI: 1.712-154.773) to have an increased risk of being associated with hepatocellular carcinoma in these BCS patients (all P<0.05). Conclusion:Postoperative alpha fetoprotein>9.0 μg/L, AST>40 U/L, intrahepatic nodule formation and vascular restenosis were independent risk factors of BCS associated with hepatocellular carcinoma in patients who underwent endovascular recanalization.

Endovascular recanalization of the symptomatic non-acute occlusion of large intracranial artery of circulation: preliminary study / 中华放射学杂志

Objective To investigate the feasibility,safety and efficacy of endovascular recanalization of the symptomatic occlusion of large intracranial artery in anterior circulation.Methods From October 2015 to December 2017,13 patients with symptomatic non-acute occlusion of large intracranial artery in anterior circulation were enrolled into this study and underwent endovascular recanalization.The initial procedural results,including the rate of successful recanalization and perioprocedural complications,and angiographic and clinical follow-up results were collected.The functional outcome was evaluated at discharge and 90 days.Results Recanalization was successful in 11 out of 13 patients.Perioperative complications occurred in 8 cases,including distal embolization in 7 cases (3 with symptom and 4 without),in which intracerebral hemorrhage associated with embolectomy was found in 1 case;and distal embolization concomitant with artery dissection in 1 case.At discharge,the symptoms of 10 out of 11 patients with successful recanalization were improved and 1 was unchanged;one of 2 patients with recanalization failure was aggravated and 1 was unchanged.After the procedure,1 patient with successful recanalization,but complicated with intracerebral hemorrhage associated with embolectomy was lost at follow-up,thus angiographic follow-up was available in the remaining 10 patients.Of the 10 patients,1 patient developed in-stent restenosis at 12 months and 9 patients had no hemodynamic stenosis/reocclusion.The clinical follow-up was available in 12 patients.No recurrence of TIA or stroke was found in 9 cases with successful recanalization except for 1 case who developed in-stent stenosis and suffered from TIA.At the follow-up of 90 days,l0 patients with successful recanalization showed good function (mRS∶0-2),2 patients with recanalization failure were deteriorated.Conclusions In strictly selected patients with symptomatic non-acute occlusion of large intracranial artery in anterior circulation,endovascular recanalization was feasible and safe,which may improve patients' symptoms in a short term and reduce the recurrence rate of stroke,but its definite efficacy needs to be confirmed by studies with larger sample and longer follow-up.

Does Clot Burden Score on Baseline T2*-MRI Impact Clinical Outcome in Acute Ischemic Stroke Treated with Mechanical Thrombectomy? / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: A long clot, defined by a low (0-6) clot burden score (CBS) assessed by T2*-MR sequence, is associated with worse clinical outcome after intravenous thrombolysis (IVT) for acute ischemic stroke than is a small clot (CBS, 7-10). The added benefit of mechanical thrombectomy (MT) might be higher in patients with long clot. The aim of this pre-specified post hoc analysis of the THRombectomie des Artères CErebrales (THRACE) trial was to assess the association between T2*-CBS, successful recanalization and clinical outcome. METHODS: Of 414 patients randomized in the THRACE trial, 281 patients were included in this analysis. Associations between T2*-CBS and clinical outcome on the modified Rankin Scale (mRS) at 3 months were tested. RESULTS: High T2*-CBS, i.e., small clot, was associated with a shift toward better outcome on the mRS; proportional odds ratio (POR) per point CBS was 1.19 (95% confidence interval [CI], 1.05 to 1.34) in the whole population, 1.34 (95% CI, 1.13 to 1.59) in IVT group, and 1.04 (95% CI, 0.87 to 1.23) in IVTMT group. After adjustment for baseline prognostic variables, the effect of the full scale T2*-CBS was not statistically significant in the whole population and for the IVTMT group but remains significant for the IVT group (POR, 1.32; 95% CI, 1.11 to 1.58). CONCLUSIONS: A small clot, as assessed using T2*-CBS, is associated with improved outcome and may be used as a prognostic marker. Despite the worst outcome with long clot, the relative benefit of MT over IVT seemed to increase with low T2*-CBS and longer clot.

CT Angiography of Collateral Vessels and Outcomes in Endovascular-Treated Acute Ischemic Stroke Patients

BACKGROUND AND PURPOSE: Measuring the extent of the collateral blood vessels using computed tomography (CT) angiography source images may promote tissue survival and functional gain in acute ischemic stroke patients who are candidates for endovascular recanalization treatment. METHODS: Of 5,558 acute stroke patients registered in a prospective clinical stroke registry, 104 met the selection criteria of endovascular recanalization treatment for internal cerebral artery or middle cerebral artery main-stem (M1) occlusions and presented for treatment ≤4 hours after the event. Using CT angiography source images, two independent and blinded reviewers measured the extent of collateral circulations at four regions, with good interrater reliability. The functional recovery at 3 months after stroke was used as an outcome variable. RESULTS: Cases with a sufficient collateral circulation at the Sylvian fissure showed significantly increased likelihood of having a modified Rankin Scale score of ≤2 at 3 months after stroke (adjusted odds ratio=3.03, 95% confidence interval=1.19–7.73, p=0.02), but the association became nonsignificant after adding the infarct volume to the model (p=0.65). The association between leptomeningeal convexity collaterals and functional recovery was no longer significant after adjusting for the infarct volume (p=0.28). The natural indirect effect of infarct volume on functional recovery was significant for both the Sylvian fissure (p=0.03) and leptomeningeal convexity (p=0.02) collaterals. CONCLUSIONS: The extent of collateral circulation at the Sylvian fissure was significantly associated with functional recovery, which may be mediated via the volume of the final infarction.

Analysis of feasibility and safety of endovascular recanalization of chronic occlusion of large intracranial artery / 中国脑血管病杂志

Objective To investigate the feasibility and safety of endovascular recanalization of chronic occlusion of large intracranial artery.Methods From January 2009 to January 2017,the clinical and imaging data of 15 patients with chronic occlusion of large intracranial artery admitted to the Department of Interventional Neuroradiology,Xuanwu Hospital,Capital Medical University for endovascular recanalization were analyzed retrospectively.Twelve patients were V4 segment occlusion of vertebral artery and 3 were internal carotid artery occlusion.Preoperative whole brain digital subtraction angiography (DSA) was used to assess the occlusion length and location.High-resolution magnetic resonance imaging (MRI) was used to evaluate the nature of occlusion and the feasibility of recanalization.The intraoperative bilateral femoral artery sheath placement was conducted in 13 cases,one side was used for recanalization and stenting,and the other side was compensated by filling the distal occlusion of the artery through collateral circulation as the reference path map,and increased the feasibility of recanalization.According to the thrombolysis in cerebral infarction (TICI) grades after procedure,the forward flow after recanalization was systematically evaluated,and grade ≥2b was defined as the success of recanalization.Results The median time between the first onset of symptoms and recanalization was 50 (range,18-365) days.The occluded recanalization sites included intracranial segment of vertebral artery in 12 cases and intracranial segment of internal carotid artery in 3 cases.Recanalization was successful in 13 cases and recanalization failure of the intracranial segment of vertebral artery was in 2 cases.Recanalization was successful in 13 cases,and intracranial vertebral artery recanalization failed in 2 cases.Of the 13 patients of successful recanalization,the forward flow of angiography returned to grade TICI 3 in 12 cases after recanalization,and returned to TICI 2b in 1 case;the symptoms of 7 cases were improved,the symptoms of 4 cases did not have any change,and the symptoms of 2 patients aggravated after procedure and developed transient ischemic attack or stroke.After 11 patients were followed up for a median of 39 (3-89) months,the median mRS score was 1 (0-2).Conclusion For recanalization of chronic large intracranial artery occlusion,using preoperative high-resolution magnetic resonance imaging evaluation and intraoperative bilateral sheath placement technique may increase the patency rate and reduce the perioperative complications.

Update of the Korean Clinical Practice Guidelines for Endovascular Recanalization Therapy in Patients with Acute Ischemic Stroke

Patients with severe stroke due to acute large cerebral artery occlusion are likely to be severely disabled or die if reperfusion is not achieved in a timely manner. Intravenous tissue plasminogen activator (IV-TPA) administered within 4.5 hours after stroke onset was previously the only proven therapy, but IV-TPA alone does not sufficiently improve the outcome of patients with acute large artery occlusion. With the introduction of the advanced endovascular therapy that enables faster and more successful recanalization, recent randomized trials consecutively and consistently demonstrated the benefit of adding endovascular recanalization therapy (ERT) to IV-TPA. Accordingly, to update the recommendations, we assembled members of a writing committee appointed by the Korean Stroke Society, the Korean Society of Interventional Neuroradiology, and the Society of Korean Endovascular Neurosurgeons. The writing committee revised recommendations based on a review of the accumulated evidence, and a formal consensus was achieved by convening a panel of 34 experts from the participating academic societies. The current guideline provides evidence-based recommendations for ERT in patients with acute large cerebral artery occlusion regarding patient selection, treatment modalities, neuroimaging evaluation, and system organization.

Update of the Korean Clinical Practice Guidelines for Endovascular Recanalization Therapy in Patients with Acute Ischemic Stroke / 대한뇌졸중학회지

Patients with severe stroke due to acute large cerebral artery occlusion are likely to be severely disabled or dead without timely reperfusion. Previously, intravenous tissue plasminogen activator (IV-TPA) within 4.5 hours after stroke onset was the only proven therapy, but IV-TPA alone does not sufficiently improve the outcome of patients with acute large artery occlusion. With the introduction of the advanced endovascular therapy, which enables more fast and more successful recanalization, recent randomized trials consecutively and consistently demonstrated the benefit of endovascular recanalization therapy (ERT) when added to IV-TPA. Accordingly, to update the recommendations, we assembled members of the writing committee appointed by the Korean Stroke Society, the Korean Society of Interventional Neuroradiology, and the Society of Korean Endovascular Neurosurgeons. Reviewing the evidences that have been accumulated, the writing members revised recommendations, for which formal consensus was achieved by convening a panel composed of 34 experts from the participating academic societies. The current guideline provides the evidence-based recommendations for ERT in patients with acute large cerebral artery occlusion regarding patient selection, treatment modalities, neuroimaging evaluation, and system organization.

Update of the Korean Clinical Practice Guidelines for Endovascular Recanalization Therapy in Patients with Acute Ischemic Stroke / 대한뇌졸중학회지

Patients with severe stroke due to acute large cerebral artery occlusion are likely to be severely disabled or dead without timely reperfusion. Previously, intravenous tissue plasminogen activator (IV-TPA) within 4.5 hours after stroke onset was the only proven therapy, but IV-TPA alone does not sufficiently improve the outcome of patients with acute large artery occlusion. With the introduction of the advanced endovascular therapy, which enables more fast and more successful recanalization, recent randomized trials consecutively and consistently demonstrated the benefit of endovascular recanalization therapy (ERT) when added to IV-TPA. Accordingly, to update the recommendations, we assembled members of the writing committee appointed by the Korean Stroke Society, the Korean Society of Interventional Neuroradiology, and the Society of Korean Endovascular Neurosurgeons. Reviewing the evidences that have been accumulated, the writing members revised recommendations, for which formal consensus was achieved by convening a panel composed of 34 experts from the participating academic societies. The current guideline provides the evidence-based recommendations for ERT in patients with acute large cerebral artery occlusion regarding patient selection, treatment modalities, neuroimaging evaluation, and system organization.

Preliminary experience of endovascular recanalization of chronic symptomatic internal carotid artery occlusion: a report of four cases / 中华神经医学杂志

Objective To summarize the preliminary experience of endovascular recanalization in treating chronic symptomatic internal carotid artery occlusion.Methods Four patients with chronic symptomatic internal carotid artery occlusion,admitted to and underwent endovascular recanalization in our hospital from August 2013 to August 2014,were chosen in our study; their clinical data were retrospectively analyzed.Results Four patients were successfully opened the internal carotid arteries;cerebral CT angiography showed that all arteries were unobstructed.One appeared intra-operative iatrogenic internal carotid artery cavernous sinus fistula,and successful occlusion of the fistula with internal carotid artery patency was achieved after one week.Three months after the operation,two showed unobstructed internal carotid artery by DSA and the other stated no abnormalities during the telephone follow up.Conclusion Endovascular recanalization is a safe and effective treatment method for chronic symptomatic internal carotid artery occlusion.

Endovascular mechanical recanalization of subclavian artery total occlusion / 介入放射学杂志

Objective To discuss the skills and effects of several endovascular mechanical techniques for the recanalization of subclavian artery total occlusion. Methods Endovascular mechanical recanalization of subclavian artery total occlusion was performed in 32 patients with symptomatic subclavian artery total occlusion. The re-open rate and the therapeutic results were observed and analyzed. Results Several endovascular mechanical techniques, including percutaneous transluminal angioplasty, were employed in treating 32 patients with subclavian artery total occlusion. After the procedure, the ischemic 8ymptoms of posterior circulation and/or upper extremity were markedly relieved. Conclusion It is safe and feasible using appropriate endovascular mechanical technique for re-canalizing the occluded subclavian artery.