Abstract
Objective To investigate the safety and efficacy of endovascular treatment for acute anterior circulation medium vessel occlusion(MeVO).Methods A retrospective,consecutive series of 31 patients with primary anterior circulation MeVO who underwent mechanical thrombectomy in the Department of Interventional Therapy(Section 1)of the First Affiliated Hospital of Dalian Medical University from February 2017 to January 2025 were included.Baseline and procedural data were collected.Baseline data included sex,age,admission National Institutes of Health stroke scale(NIHSS)score,admission Alberta stroke program early CT score(ASPECTS),hypertension,diabetes,smoking,atrial fibrillation,occlusion site(M2 or M3 segment of middle cerebral artery,A2 or A3 segment of anterior cerebral artery),and trial of Org 10172 in acute stroke treatment(TOAST)classification.Procedural data included onset-to-femoral artery puncture time(≤6 h,＞6-＜12h,12-24h),femoral artery puncture-to-reperfusion time(≤60min,＞60-＜120min,≥120min;for unsuccessful reperfusion femoral artery puncture-to-reperfusion time was defined as puncture-to-procedure end time),intravenous thrombolysis,first-line MT technique(including primary stent retriever thrombectomy,primary contact aspiration thrombectomy,thrombus fragmentation with microguidewire),number of thrombectomy attempts,rescue measures(balloon angioplasty,stenting,or combined balloon angioplasty and stenting),and immediate postoperative reperfusion status(with thrombolysis in cerebral infarction[TICI]grade 0-2a defined as reperfusion failure,2b-3 defined as successful reperfusion).Neurological function at 3 months was assessed using the modified Rankin scale(mRS)and patients were divided into a favorable outcome group(mRS score 0-2)and a poor outcome group(mRS score 3-6).Safety outcomes included intracranial hemorrhage hemorrhage within 24 h(symptomatic intracranial hemorrhage[confirmed by CT within 24 h postoperatively with a NIHSS score increase of≥4 points from baseline],asymptomatic subarachnoid hemorrhage[confirmed by CT within 24 h postoperatively without typical symptoms like headache,nausea,or impaired consciousness]),procedure-related complications(arterial dissection[non-flow-limiting],vessel perforation,vasospasm,distal embolization),and all-cause mortality at 3 months.Efficacy outcomes included immediate postoperative successful reperfusion rate and proportion of patients with good functional outcome(mRS score 0-2)at 90 days.Results(1)Among the 31 anterior circulation MeVO patients meeting the criteria,19 were male,and 12 were female,aged 57-86 years,mean age(69±10)years.The median admission NIHSS score was15.0(12.5,17.0),ranged 6-30score.Atrial fibrillation was the most common cerebrovascular risk factor(74.2%,23/31),followed by hypertension(54.8%,17/31).Cardioembolism was the predominant TOAST subtype(74.2%,23/31),with 16.1%(5/31)having large-artery atherosclerosis.Among all patients enrolled,there were 30 cases with occlusion site at M2 segment of middle cerebral artery and1case at A2 segment of anterior cerebral artery.(2)Twenty-five patients(80.6%)received endovascular treatment within 6 h of onset,and 6(19.3%)in＞6-＜12 h(median time 8.00[6.75,10.25]h).Femoral artery puncture-to-reperfusion time was within 120 min for 26patients(83.9%).Eight patients(25.8%)received bridging treatment with intravenous thrombolysis before endovascular therapy.Twenty-seven patients received primary Solitaire stent retriever thrombectomy,with a mean of(1.1±0.2)retrieval attempts.In one patient,near-occlusive severe stenosis persisted after primary Solitaire thrombectomy,which was successfully treated with rescue stenting angioplasty,achieving TICI grade 3 flow.Three patients underwent primary thrombus fragmentation with microguidewire,with 2 cases achieved TICI grade of 2b in two and 1 case obtained a TICI grade of 2a immediately after the surgery.At 3-month follow-up,two had an mRS score of 3 and one of 0.One patient underwent primary contact aspiration thrombectomy,achieving immediate TICI grade 3 and a mRS score of 1 at 3 months.(3)For safety assessment,procedure-related complications occurred intraoperatively in 6 cases,including distal embolization to M4 segment in 2 patients which were treated with local administration of 2 ml tirofiban leading to partial dissolution.Intraoperative non-flow-limiting dissection occurred in 2 patients and culprit vessel vasospasm occurred in 2.Asymptomatic subarachnoid hemorrhage occurred in 2 M2 occlusion patients,managed conservatively without new symptoms.Two patients died during hospitalization(one from gastrointestinal bleeding,one from myocardial infarction).No new deaths occurred within 3 months post-discharge.(4)To assess the efficacy,among 31 patients,27(87.1%)achieved immediate successful reperfusion,with 18 achieving TICI grade 3.At the 3-month follow-up,16 patients were in the favorable outcome group and 15 in the poor outcome group.Compared with the poor outcome group,the favorable outcome group had a higher proportion of male patients(13/16 vs.6/15,P=0.029),a higher admission ASPECTS(9.00[8.75,9.25]score vs.8.00[7.00,8.50]score,P=0.042),and a lower proportion of hypertension(3/16 vs.14/15,P=0.001).No statistically significant differences were found in other comparisons between the groups(all P＞0.05).Conclusion Endovascular therapy for acute anterior circulation MeVO achieved a high rate of successful reperfusion and can lead to favorable clinical outcomes,although procedure-related complications still require attention.关键词
前循环/颅内中等血管闭塞/机械取栓/血管再通/预后Key words
Anterior circulation/Medium vessel occlusion/Thrombectomy/Recanalization/Prognosis
