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Endovascular Recanalization of Non-acute Symptomatic Middle Cerebral Artery Total Occlusion and Its Short-Term Outcomes.

ABSTRACT: Background and Purpose: The optimal treatment for patients with non-acute symptomatic middle cerebral artery (MCA) total occlusion and a high risk of recurrent ischemic stroke despite medical management is not well-established. We aimed to assess the feasibility, safety, and short-term outcomes of angioplasty and stenting for these patients. Methods: Data of 22 patients with non-acute symptomatic MCA total occlusion who have failed medical management and undergone endovascular recanalization were retrospectively collected in our prospective database. All occlusive lesions were predilated with conventional balloons, followed by paclitaxel-coated coronary balloon inflation or not, and then a remedial stenting was performed or not, depending on the discretion of the operator. The rate of successful recanalization, perioperative outcomes, and short-term outcomes, such as restenosis and stroke recurrence, was analyzed. Results: Successful recanalization was achieved in 95.5% of patients, with 14 patients undergoing balloon angioplasty and 7 patients undergoing remedial stenting. Seven patients developed perioperative complications, including one patient with persistent neurological deficit. Over a median clinical follow-up duration of 5.0 months, only one patient had recurrent ischemic symptoms attributed to the cessation of antiplatelet treatment owing to postoperative intracranial hemorrhage. The proportion of patients who achieved favorable clinical outcome (modified ranking scale score of 0-2) was 85.7%. Post-procedural repeat vascular imaging was performed at 4.5 ± 1.84 months, with nine and one patient undergoing cerebral angiography and magnetic resonance angiography, respectively. One (10%) artery presented with asymptomatic reocclusion. Conclusions: Angioplasty and stenting may be feasible for the patients with non-acute symptomatic atherosclerotic MCA total occlusive disease who have failed medical management.

SUBMITTER: Zheng M

PROVIDER: S-EPMC6529837 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Endovascular Recanalization of Non-acute Symptomatic Middle Cerebral Artery Total Occlusion and Its Short-Term Outcomes.

Zheng Meimei M Song Yun Y Zhang Jinping J Zhao Wei W Sun Lili L Yin Hao H Zhang Jun J Wang Wei W Han Ju J

Frontiers in neurology 20190515

<b>Background and Purpose:</b> The optimal treatment for patients with non-acute symptomatic middle cerebral artery (MCA) total occlusion and a high risk of recurrent ischemic stroke despite medical management is not well-established. We aimed to assess the feasibility, safety, and short-term outcomes of angioplasty and stenting for these patients. <b>Methods:</b> Data of 22 patients with non-acute symptomatic MCA total occlusion who have failed medical management and undergone endovascular reca ...[more]

PMID: 31156533

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Project description:BackgroundThere is growing evidence suggesting efficacy of endovascular therapy for M2 occlusions of the middle cerebral artery. More than one recanalization attempt is often required to achieve successful reperfusion in M2 occlusions, associated with general concerns about the safety of multiple maneuvers in these medium vessel occlusions.AimThe aim of this study was to investigate the association between the number of recanalization attempts and functional outcomes in M2 occlusions in comparison with large vessel occlusions (LVO).MethodsRetrospective multicenter cohort study of patients who underwent endovascular therapy for primary M2 occlusions. Patients were enrolled in the German Stroke Registry at 1 of 25 comprehensive stroke centers between 2015 and 2021. The study cohort was subdivided into patients with unsuccessful reperfusion (mTICI 0-2a) and successful reperfusion (mTICI 2b-3) at first, second, third, fourth, or ⩾fifth recanalization attempt. Primary outcome was 90-day functional independence defined as modified Rankin Scale score of 0-2. Safety outcome was the occurrence of symptomatic intracranial hemorrhage. Internal carotid artery or M1 occlusions were defined as LVO and served as comparison group.ResultsA total of 1078 patients with M2 occlusion were included. Successful reperfusion was observed in 87.1% and 90-day functional independence in 51.9%. The rate of functional independence decreased gradually with increasing number of recanalization attempts (p < 0.001). In both M2 occlusions and LVO, successful reperfusion within three attempts was associated with greater odds of functional independence, while success at ⩾fourth attempt was not. Patients with ⩾4 attempts exhibited higher rates of symptomatic intracranial hemorrhage in M2 occlusions (6.5% vs 2.7%, p = 0.02) and LVO (7.2% vs 3.5%, p < 0.001).ConclusionThis study suggests a clinical benefit of successful reperfusion within three recanalization attempts in endovascular therapy for M2 occlusions, which was similar in LVO. Our findings reduce concerns about the risk-benefit ratio of multiple attempts in M2 medium vessel occlusions.Data access statementThe data that support the findings of this study are available on reasonable request after approval of the German Stroke Registry (GSR) steering committee.Clinical trial registration informationClinicalTrials.gov Identifier: NCT03356392.

Project description:Rigorous screening and good imaging would help perform surgery on carotid artery occlusion CAO safely and effectively. The purpose of this study was to retrospectively evaluate carotid endarterectomy (CEA) recanalization in patients with common carotid artery occlusion (CCAO) or internal carotid artery occlusion (ICAO) with color Doppler flow imaging (CDFI). A total of 59 patients undergoing CEA were enrolled. According to the results of CEA, the patients were divided into successful recanalization (group A) and unsuccessful recanalization (group B) groups. The original diameter, lesion length, proximal-to-distal diameter ratio and echo characteristics of the lesion within the lumen of the carotid artery were recorded before CEA and compared between the two groups. In regards to the achievement of repatency by CEA, the overall success rate was 74.6% (44/59), the success rate in CCAO patients was 75.9% (22/29) and the success rate in ICAO patients was 73.3% (22/30). There was no significant difference in the success rates between the CCAO and ICAO patients (χ2 = 0.050, P = 0.824). The overall rate of stroke and death within 30 postoperative days was 5.1% (3/59). For the CCAO patients, the lesion length in group A was shorter than that in group B (t = 3.221, P = 0.004). For the ICAO patients, the original diameter of the distal ICA was broader (t = 6.254, P = 0.000) and the proximal-to-distal ICA diameter ratio was smaller (t = 8.036, P = 0.000) in group A than in group B. The rate of recanalization for lumens with a homogeneous echo pattern (hypoecho or isoecho) was significantly higher than that for lumens with echo heterogeneity for both the CCAO and ICAO patients (χ2 = 14.477, P = 0.001; χ2 = 10.519, P = 0.003). However, for both the CCAO and ICAO patients, there was no difference in the rate of recanalization between patients with hypoecho and isoecho lesions (χ2 = 0.109, P = 0.742; χ2 = 0.836, P = 0.429). The original diameter, proximal-to-distal ICA diameter ratio, lesion length and echo characteristics may affect the success of CEA recanalization in patients with CCAO and ICAO. CDFI is helpful in screening patients with carotid artery occlusion and may improve the success rate of CEA.

Project description:Objective: This work explores collateral circulation metrics, such as the anterior borderzone angle grading (ABZA-grading), as a predictor of the prognosis in patients with acute middle cerebral artery occlusion (MCAO) following endovascular treatment (EVT). Methods: Clinical data from 108 patients with acute MCAO, treated by EVT, were retrospectively analyzed. In patients with MCAO, ABZA is the angle between the median line of the sagittal sinus and the borderzone of the pial arterioles of ACA and MCA, and the ABZA/23.0° was rounded to obtain the corresponding collateral circulation score (ABZA-grading). In parallel, the primary outcome was defined as the 90-day clinical outcome by modified ranking scale score (mRS). Univariate analysis and logistic regression were used to analyze the independent predictors of the 90-day clinical outcome (mRS). Receiver operating characteristic curve (ROC) analysis was used to judge the predictive value of ABZA. Results: Univariate analysis and logistic regression analysis showed that ABZA-grading > 2 and age were independent predictors of the 90-day clinical outcome after EVT in patients with acute MCAO. The ROC analysis showed that ABZA alone could predict a favorable 90-day clinical outcome with an area under the curve (AUC) of 0.868. Using an ABZA of >57.8° (the corresponding ABZA-grading of >2) as the cut-off value, the predictive sensitivity and specificity were 75.7 and 88.7%, respectively. Contingency table analysis showed a statistical difference in mRS score between ABZA-grading subgroups, and ABZA-grading between stroke caused by large artery atherosclerosis (LAA) and cardiogenic embolism (CE). Conclusion: The ABZA-grading is an easy and objective assessment of collateral circulation that is independently associated with short-time clinical outcome after EVT in patients with acute MCAO. Therefore, it may guide selection of patients with acute ischemic stroke (AIS) suitable for EVT. The ABZA-grading of collateral circulation can be a supplemental metric to help differentiate stroke by LAA and CE.

Dataset Information

Endovascular Recanalization of Non-acute Symptomatic Middle Cerebral Artery Total Occlusion and Its Short-Term Outcomes.

Publications

Endovascular Recanalization of Non-acute Symptomatic Middle Cerebral Artery Total Occlusion and Its Short-Term Outcomes.

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