Application of angioplasty in non-acute stage of intracranial large artery occlusion guided by highresolution magnetic resonance imaging / 中国脑血管病杂志

ABSTRACT

Objective To evaluate the feasibility, safety and clinical efficacy of endovascular angioplasty for symptomatic, non-acute occlusion of the large intracranial artery under the guidance of highresolution magnetic resonance imaging (HR-MRI). Methods A total of 31 patients with symptomatic and subacute or chronic occlusion of the large intracranial artery in the Department of Interventional Therapy, First Affiliated Hospital of Dalian Medical University from June 2017 to December 2019 was analyzed retrospectively. The location of luminal and plaque at the occlusion segment were evaluated by HR-MRI to determine the characteristic of the occlusion (thrombosis or substantial occlusion of the wall), and obtain the relationship between the plaque distribution of intracranial artery and the opening location of perforating artery. According to the evaluation results, 26 patients were screened for recanalization with angioplasty. The success rate of surgical technique, perioperative complications, and the outcomes of postoperative clinical and imaging follow-up were evaluated. The modified Rankin scale (mRS) was used to assess the patient's prognosis. Results Of the 26 patients undergoing surgery, 22 cases were successful in recanalizing the occlusion vessel; 4 cases were failed to open due to the guidewire was difficult to pass through the occlusion segment, of which one case was occluded at the C6 segment of the internal carotid artery, two cases were occluded at the segment of the intracranial vertebral artery, and one case was occluded at the basilar artery. There were 2 cases with complications during the operation, both of which were asymptomatic peripheral embolism, and there were no complications of bleeding and death during the perioperative period. The median follow-up time in 22 successful patients was 12 (3, 21) months. There were no deaths or losses to follow-up. The median mRS score was 1 (1,3). There were no recurrent stroke or transient ischemic attacks. Two cases of asymptomatic in-stent restenosis occurred without adverse reactions and adverse consequences. Four failed patients had a median follow-up time of 11 (3, 18) months. There were no deaths or losses to follow-up. The median mRS score was 2(2, 3). There were 1 case of recurrent stroke and 2 cases of transient ischemic attacks, respectively. Conclusions For patients with symptomatic occlusion of the large intracranial artery in non-acute stage, It is safe and feasible with angioplasty for selected patients guided by HR-MRI to evaluate the occlusion length, pathological nature and latent space of the occlusion segment, and combined with other clinical conditions, which can improve the short-term outcomes of patients' ischemic symptoms and reduce the rate of recurrent stroke. However, the long-term efficacy needs to be confirmed with long-term follow-up.