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Neuroradiology

Erschienen in:

06.01.2024 | Interventional Neuroradiology

Balloon angioplasty as first-choice recanalization strategy for intracranial atherosclerosis-related emergent large vessel occlusion with small clot burden

verfasst von: Liang Zhang, Xiong’jun He, Kai’feng Li, Li Ling, Min Peng, Li’an Huang, Ya’jie Liu

Erschienen in: Neuroradiology | Ausgabe 3/2024

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Abstract

Purpose

The optimal primary recanalization strategy for intracranial atherosclerosis-related emergent large vessel occlusion (ICAS-ELVO) remains controversial. We aimed to explore the safety and efficacy of balloon angioplasty as the first-choice recanalization strategy for ICAS-ELVO with small clot burden.

Methods

Consecutive ICAS-ELVO patients presenting with microcatheter “first-pass effect” during endovascular treatment (EVT) were retrospectively analyzed. Patients were divided into preferred balloon angioplasty (PBA) and preferred mechanical thrombectomy (PMT) groups based on the first-choice recanalization strategy. The reperfusion and clinical outcomes between the two groups were compared.

Results

Seventy-six patients with ICAS-ELVO involving the microcatheter “first-pass effect” during EVT were enrolled. Compared with patients in the PMT group, those in the PBA group were associated with (i) a higher rate of first-pass recanalization (54.0% vs. 28.9%, p = .010) and complete reperfusion (expanded thrombolysis in cerebral ischemia ≥ 2c; 76.0% vs. 53.8%, p = .049), (ii) shorter puncture-to-recanalization time (49.5 min vs. 89.0 min, p < .001), (iii) lower operation costs (¥48,499.5 vs. ¥ 99,086.0, p < .001), and (iv) better 90-day functional outcomes (modified Rankin scale:0–1; 44.0% vs. 19.2%, p = .032). Logistic regression analysis revealed that balloon angioplasty as the first-choice recanalization strategy was an independent predictor of 90-day excellent functional outcomes for ICAS-ELVO patients with microcatheter “first-pass effect” (adjusted odds ratio = 6.01, 95% confidence interval: 1.15–31.51, p = .034).

Conclusion

Direct balloon angioplasty potentially improves 90-day functional outcomes for ICAS-ELVO patients with small clot burden, and may be a more appropriate first-choice recanalization strategy than mechanical thrombectomy for these patients.

Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ et al (2015) A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372:11–20. https://doi.org/10.1056/NEJMoa1411587CrossRefPubMed

Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N et al (2015) Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372:1009–1018. https://doi.org/10.1056/NEJMoa1414792CrossRefPubMed

Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J et al (2015) Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372:1019–1030. https://doi.org/10.1056/NEJMoa1414905CrossRefPubMed

Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM et al (2015) Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 372:2285–95. https://doi.org/10.1056/NEJMoa1415061CrossRefPubMed

Jovin TG, Chamorro A, Cobo E, Miquel MAD, Munuera J (2015) Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372:2296–2306. https://doi.org/10.1056/NEJMoa1503780CrossRefPubMed

Kim YW, Hong JM, Park DG, Choi JW, Kang DH, Kim YS et al (2016) Effect of intracranial atherosclerotic disease on endovascular treatment for patients with acute vertebrobasilar occlusion. AJNR Am J Neuroradiol 37:2072–2078. https://doi.org/10.3174/ajnr.A4844CrossRefPubMedPubMedCentral

Hwang YH, Kim YW, Kang DH, Kim YS, Liebeskind DS (2016) Impact of target arterial residual stenosis on outcome after endovascular revascularization. Stroke 47:1805–1807. https://doi.org/10.1161/STROKEAHA.116.014694CrossRef

Lee JS, Lee SJ, Hong JM, Alverne F, Lima FO, Nogueira RG (2022) Endovascular Treatment of Large Vessel Occlusion Strokes Due to Intracranial Atherosclerotic Disease. J Stroke 24:3–20. https://doi.org/10.5853/jos.2021.01375CrossRefPubMedPubMedCentral

Tsang ACO, Orru E, Klostranec JM, Yang IH, Lau KK, Tsang FCP et al (2019) Thrombectomy outcomes of intracranial atherosclerosis-related occlusions. Stroke 50:1460–1466. https://doi.org/10.1161/STROKEAHA.119.024889CrossRefPubMed

10.

Zhang J, Jia B, Pan Y, Yu Z, Deng Y, Mo D et al (2022) A comparison between different endovascular treatment strategies for acute large vessel occlusion due to intracranial artery atherosclerosis: data from ANGEL-ACT Registry. Neuroradiology 64:1627–1638. https://doi.org/10.1007/s00234-022-02933-wCrossRefPubMed

11.

Ma G, Sun X, Tong X, Jia B, Huo X, Luo G et al (2021) Safety and Efficacy of Direct Angioplasty in Acute Basilar Artery Occlusion Due to Atherosclerosis. Front Neurol 12:651653. https://doi.org/10.3389/fneur.2021.651653CrossRefPubMedPubMedCentral

12.

Luo Y, Huang J, Yang Y, Liu H, Chen X, Li X et al (2020) Effect of direct angioplasty therapy on acute middle cerebral artery occlusion with good leptomeningeal collateral. Clin Neurol Neurosurg 190:105744. https://doi.org/10.1016/j.clineuro.2020.105744CrossRefPubMed

13.

Yi TY, Chen WH, Wu YM, Zhang MF, Zhan AL, Chen YH et al (2019) Microcatheter “First-Pass Effect” Predicts Acute Intracranial Artery Atherosclerotic Disease-Related Occlusion. Neurosurgery 84:1296–1305. https://doi.org/10.1093/neuros/nyy183CrossRefPubMed

14.

Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL et al (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 24:35–41. https://doi.org/10.1161/01.str.24.1.35CrossRefPubMed

15.

Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K et al (2018) 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 49:e46–e110. https://doi.org/10.1161/STR.0000000000000158CrossRefPubMed

16.

McTaggart RA, Ospel JM, Psychogios MN, Puri AS, Maegerlein C, Lane KM et al (2020) Optimization of endovascular therapy in the neuroangiography suite to achieve fast and complete (Expanded treatment in cerebral ischemia 2c–3) reperfusion. Stroke 51:1961–1968. https://doi.org/10.1161/STROKEAHA.119.026736CrossRefPubMed

17.

Almekhlafi MA, Mishra S, Desai JA, Nambiar V, Volny O, Goel A et al (2014) Not all “successful” angiographic reperfusion patients are an equal validation of a modified TICI scoring system. Interv Neuroradiol 20:21–27. https://doi.org/10.15274/INR-2014-10004CrossRefPubMedPubMedCentral

18.

Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira RG et al (2012) Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet 380:1241–1249. https://doi.org/10.1016/S0140-6736(12)61384-1CrossRefPubMed

19.

Kang DH, Yoon W (2019) Current Opinion on Endovascular Therapy for Emergent Large Vessel Occlusion Due to Underlying Intracranial Atherosclerotic Stenosis. Korean J Radiol 20:739–748. https://doi.org/10.3348/kjr.2018.0809CrossRefPubMedPubMedCentral

20.

Treurniet KM, Yoo AJ, Berkhemer OA, Lingsma HF, Boers AM, Fransen PS et al (2016) Clot Burden Score on Baseline Computerized Tomographic Angiography and Intra-Arterial Treatment Effect in Acute Ischemic Stroke. Stroke 47:2972–2978. https://doi.org/10.1161/STROKEAHA.116.014565CrossRefPubMed

21.

Derraz I, Bourcier R, Soudant M, Soize S, Hassen WB, Hossu G et al (2019) Does clot burden score on baseline T2*-MRI impact clinical outcome in acute ischemic stroke treated with mechanical thrombectomy? J Stroke 21:91–100. https://doi.org/10.5853/jos.2018.01921CrossRefPubMedPubMedCentral

22.

Derraz I, Pou M, Labreuche J, Legrand L, Soize S, Tisserand M et al (2021) Clot burden score and collateral status and their impact on functional outcome in acute ischemic stroke. AJNR Am J Neuroradiol 42:42–48. https://doi.org/10.3174/ajnr.A6865CrossRefPubMedPubMedCentral

23.

Nikoubashman O, Dekeyzer S, Riabikin A, Keulers A, Reich A, Mpotsaris A et al (2019) True first-pass effect. Stroke 50:2140–2146. https://doi.org/10.1161/STROKEAHA.119.025148CrossRefPubMed

24.

Jia B, Feng L, Liebeskind DS, Huo X, Gao F, Ma N et al (2018) Mechanical thrombectomy and rescue therapy for intracranial large artery occlusion with underlying atherosclerosis. J Neurointerv Surg 10:746–750. https://doi.org/10.1136/neurintsurg-2017-013489CrossRefPubMed

25.

Yoon W, Kim SK, Park MS, Kim BC, Kang HK (2015) Endovascular treatment and the outcomes of atherosclerotic intracranial stenosis in patients with hyperacute stroke. Neurosurgery. 76:680–6. https://doi.org/10.1227/NEU.0000000000000694. (discussion 6)CrossRefPubMed

26.

Kim YW, Sohn SI, Yoo J, Hong JH, Kim CH, Kang DH et al (2020) Local tirofiban infusion for remnant stenosis in large vessel occlusion: tirofiban ASSIST study. BMC Neurol 20:284. https://doi.org/10.1186/s12883-020-01864-4CrossRefPubMedPubMedCentral

27.

Investigators RBT, Qiu Z, Li F, Sang H, Luo W, Liu S et al (2022) Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke: The RESCUE BT Randomized Clinical Trial. JAMA 328:543–553. https://doi.org/10.1001/jama.2022.12584CrossRef

28.

Li H, Ma HY, Zhang L, Liu P, Zhang YX, Zhang XX et al (2022) Early diagnosis of intracranial atherosclerotic large vascular occlusion: A prediction model based on DIRECT-MT data. Front Neurol 13:1026815. https://doi.org/10.3389/fneur.2022.1026815CrossRefPubMedPubMedCentral

29.

Liang W, Wang Y, Du Z, Mang J, Wang J (2021) Intraprocedural angiographic signs observed during endovascular thrombectomy in patients with acute ischemic stroke: a systematic review. Neurology 96:1080–1090. https://doi.org/10.1212/WNL.0000000000012069CrossRefPubMed

30.

Baek JH, Kim BM (2019) Angiographical Identification of Intracranial, Atherosclerosis-Related, Large Vessel Occlusion in Endovascular Treatment. Front Neurol 10:298. https://doi.org/10.3389/fneur.2019.00298CrossRefPubMedPubMedCentral

31.

Zhang Y, He G, Lu J, Miao G, Liang D, Wang J et al (2023) Thrombus Enhancement Sign May Differentiate Embolism From Arteriosclerosis-Related Large Vessel Occlusion. J Stroke 25:233–241. https://doi.org/10.5853/jos.2022.03489CrossRefPubMedPubMedCentral

32.

Kishi F, Nakagawa I, Kimura S, Ogawa D, Yagi R, Yamada K et al (2023) Tmax volume can predict clinical type in patients with acute ischemic stroke. Brain Behav 13:e3163. https://doi.org/10.1002/brb3.3163CrossRefPubMedPubMedCentral

Titel: Balloon angioplasty as first-choice recanalization strategy for intracranial atherosclerosis-related emergent large vessel occlusion with small clot burden
verfasst von: Liang Zhang
Xiong’jun He
Kai’feng Li
Li Ling
Min Peng
Li’an Huang
Ya’jie Liu
Publikationsdatum: 06.01.2024
Verlag: Springer Berlin Heidelberg
Erschienen in: Neuroradiology / Ausgabe 3/2024
Print ISSN: 0028-3940
Elektronische ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-023-03278-8

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