Journal of Neuroendovascular Therapy
Online ISSN : 2186-2494
Print ISSN : 1882-4072
ISSN-L : 1882-4072

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Emergency Carotid Artery Stenting in Acute Ischemic Stroke
Nobuyuki OharaSatoshi TateshimaJames SayreGary R DuckwilerReza JahanNestor R GonzalezPaul M VespaLatisha K AliSidney StarkmanJeffrey L SaverDavid S Liebeskind
著者情報
ジャーナル オープンアクセス 早期公開

論文ID: oa.2015-0038

この記事には本公開記事があります。
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Objectives: Some acute stroke patients with intracranial arterial occlusion have concomitant extracranial carotid artery occlusion or high-grade stenosis. Emergency carotid artery stenting (CAS) is a potentially effective treatment option to enhance intracranial reperfusion for these patients, yet selection of optimal candidates for this procedure remains elusive.Methods: We analyzed clinical data of patients who underwent emergency CAS in the setting of acute endovascular recanalization from 2005 to 2012. Reperfusion was graded with modified Thrombolysis in Cerebral Infarction (mTICI) scale. Clinical outcomes were assessed by modified Rankin Scale (mRS) at 90 days.Results: 23 patients were included with mean age of 64.2 years, median admission NIHSS score of 20. The median initial Alberta Stroke Program Early CT Score on diffusion-weighted imaging (DWI-ASPECTS) was 7. 18 patients (78.3%) had internal carotid artery occlusion at the origin. 19 patients (82.6%) had intracranial tandem arterial occlusions. All patients successfully underwent CAS and 14 patients (60.9%) underwent additional mechanical thrombectomy. Nine patients (39.1%) were mTICI grade ≥2b. Hemorrhagic transformation with parenchymal hematoma (PH) occurred in nine patients (39.1%). At follow-up, six patients (26.1%) had a favorable outcome (mRS 0-2). The multiple logistic model yielded age (OR 1.20, 95% CI [1.02, 1.41], P = 0.03) and initial DWI-ASPECTS (OR 0.25, 95% CI [0.07, 0.92], P = 0.04) independently associated with an unfavorable outcome (mRS 3-6) and additional mechanical thrombectomy (OR 2.5, P = 0.005) was associated with PH.Conclusions: Endovascular recanalization with emergency CAS is technically feasible. Further refinement of patient selection may reduce postprocedural hemorrhaghic transformation and optimize resultant clinical outcomes.
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© 2016 The Japanese Society for Neuroendovascular Therapy

This article is licensed under a Creative Commons [Attribution-NonCommercial-NoDerivatives 4.0 International] license.
https://creativecommons.org/licenses/by-nc-nd/4.0/
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