Aim:The safety and efficacy of the endovascular recanalisation therapy(ERT)for a-cute ischemic stroke caused by proximal intracerebral occlusion of the anterior circulation has been proved.Due to the high mortality an...Aim:The safety and efficacy of the endovascular recanalisation therapy(ERT)for a-cute ischemic stroke caused by proximal intracerebral occlusion of the anterior circulation has been proved.Due to the high mortality and disability of Acute VBAO,more attention has been attached to endovascular recanalisation therapy.However,the effectiveness of ERT for Acute completely VBAO was not well demonstrated.Methods:The clinical and angiographic data of 13 patients who received ERT for acute posterior circulation ischemic stroke caused by acute completely VBAO in our endovascular database from 2011 to 2015 were retrospectively analyzed.Successful recanalisation was defined as Thrombolysis in Cerebral Infarction(TICI)grade≥2b.The modified Rankin scale(mRS)score was used to measure outcome.Results:13 patients with a mean age of 62.5 years were included in the study(11 men and 2 women).The mean time from symptom onset to treatment was(539.0±267.7)min.The National Institutes of Health Stroke Scale(NIHSS)and GlasgowComa Scale(GCS)score on admission were 21.1(range 6-30)and 8.6(range 4-14),respectively.Recanalization(TICI≥2b)was successful in 11 of our 13 patients(84.6%),with the TICI grade of 3 in six patients and 2b in five patients.One patient(7.7%)suffered a symptomatic intracerebral hemorrhage.At 3 months,38.5%(5/13)overall had good and moderate outcome(mRS≤3);42.8.5%of patients treated with an Solitaire stent retrievers procedure as the initial ERT and 16.7%of patients treated with IAT as the initial ERT had good outcome(mRS≤2).The overall mortality rate was 53.8%(7 of 13)at 3 months.Conclusions:ERT may be effective and safe for acute completely vertebrobasilar artery occlusion(VBAO)in acute posterior circulation ischemic stroke patients;the Solitaire stent retrievers procedure(compared to intra-arterial thrombolysis,IAT)may have greater efficacy and safety.展开更多
Objective The Antiplatelet versus R-tPA for Acute Mild Ischaemic Stroke trial has demonstrated the non-inferiority of dual antiplatelet therapy(DAPT)to alteplase in minor non-disabling stroke.This prespecified seconda...Objective The Antiplatelet versus R-tPA for Acute Mild Ischaemic Stroke trial has demonstrated the non-inferiority of dual antiplatelet therapy(DAPT)to alteplase in minor non-disabling stroke.This prespecified secondary analysis aimed to investigate whether the treatment effects were similar across stroke territories.Methods Participants were divided according to stroke territory,which were subdivided into DAPT and alteplase.An excellent functional outcome at 90 days defined as modified Rankin Scale scoring 0–1 was primary outcome.National Institutes of Health Stroke Scale(NIHSS)score change and early neurological improvement measured by a 2-point decline in NIHSS score at 24 hours were secondary outcomes.Symptomatic intracerebral haemorrhage(sICH)and bleeding events were safety outcomes.Primary analyses adjusted unbalanced baseline characteristics between treatments by multivariate logistic regression.Results A total of 719 patients were included:566 in anterior circulation stroke(ACS)and 153 in posterior circulation stroke(PCS).Primary outcome was 94.1%in DAPT and 91.7%in alteplase among ACS patients(adjusted risk difference(RD)and 95%CI,1.5%(−1.5%to 4.6%),p=0.32),while 91.2%in DAPT and 91.8%in alteplase among PCS patients(adjusted RD and 95%CI,−2.1%(−8.5%to 4.4%),p=0.53).Compared with alteplase,DAPT was associated with lower risk of sICH(p=0.03)and bleeding events(p<0.001)in ACS,but only lower risk of bleeding events(p=0.007)in PCS.Additionally,among ACS patients,the alteplase was superior to DAPT in terms of decrease in NIHSS score at 24 hours compared with admission(adjusted geometric mean ratio and 95%CI,−0.09(−0.16 to−0.03),p=0.005)and early neurological improvement(adjusted RD and 95%CI,−7.2%(−11.6%to−2.7%),p=0.001).Conclusion Among ischaemic stroke with minor non-disabling symptoms,DAPT was similar with intravenous alteplase regarding long-term functional outcome and better safety regardless of ACS or PCS.The potential benefit of intravenous alteplase regarding early neurological improvement in patients with ACS warrants further investigation.Trial registration number NCT03661411.展开更多
Posterior circulation stroke may rarely be associated with occlusive disease in the anterior circulation, such as in the context of a direct （fetal） origin of the posterior cerebral artery （PCA） from the internal ...Posterior circulation stroke may rarely be associated with occlusive disease in the anterior circulation, such as in the context of a direct （fetal） origin of the posterior cerebral artery （PCA） from the internal carotid artery （ICA）, or in the presence of a persistent trigeminal artery （PTA） or persistent hypoglossal artery （PHA）. Usually, they happened as infarction involving both ipsilateral carotid and posterior cerebral artery territories with carotid atherosclerosis etiology.3 Here, we reported a rare case with cadioembolic occlusion of the ICA presented with infarction mainly in the PCA territory.展开更多
基金Supported by National Natural Science Foundation of China(81271280)
文摘Aim:The safety and efficacy of the endovascular recanalisation therapy(ERT)for a-cute ischemic stroke caused by proximal intracerebral occlusion of the anterior circulation has been proved.Due to the high mortality and disability of Acute VBAO,more attention has been attached to endovascular recanalisation therapy.However,the effectiveness of ERT for Acute completely VBAO was not well demonstrated.Methods:The clinical and angiographic data of 13 patients who received ERT for acute posterior circulation ischemic stroke caused by acute completely VBAO in our endovascular database from 2011 to 2015 were retrospectively analyzed.Successful recanalisation was defined as Thrombolysis in Cerebral Infarction(TICI)grade≥2b.The modified Rankin scale(mRS)score was used to measure outcome.Results:13 patients with a mean age of 62.5 years were included in the study(11 men and 2 women).The mean time from symptom onset to treatment was(539.0±267.7)min.The National Institutes of Health Stroke Scale(NIHSS)and GlasgowComa Scale(GCS)score on admission were 21.1(range 6-30)and 8.6(range 4-14),respectively.Recanalization(TICI≥2b)was successful in 11 of our 13 patients(84.6%),with the TICI grade of 3 in six patients and 2b in five patients.One patient(7.7%)suffered a symptomatic intracerebral hemorrhage.At 3 months,38.5%(5/13)overall had good and moderate outcome(mRS≤3);42.8.5%of patients treated with an Solitaire stent retrievers procedure as the initial ERT and 16.7%of patients treated with IAT as the initial ERT had good outcome(mRS≤2).The overall mortality rate was 53.8%(7 of 13)at 3 months.Conclusions:ERT may be effective and safe for acute completely vertebrobasilar artery occlusion(VBAO)in acute posterior circulation ischemic stroke patients;the Solitaire stent retrievers procedure(compared to intra-arterial thrombolysis,IAT)may have greater efficacy and safety.
基金Science and Technology Project Plan of Liaoning Province(2023-MSLH-348,2022JH2/101500020)。
文摘Objective The Antiplatelet versus R-tPA for Acute Mild Ischaemic Stroke trial has demonstrated the non-inferiority of dual antiplatelet therapy(DAPT)to alteplase in minor non-disabling stroke.This prespecified secondary analysis aimed to investigate whether the treatment effects were similar across stroke territories.Methods Participants were divided according to stroke territory,which were subdivided into DAPT and alteplase.An excellent functional outcome at 90 days defined as modified Rankin Scale scoring 0–1 was primary outcome.National Institutes of Health Stroke Scale(NIHSS)score change and early neurological improvement measured by a 2-point decline in NIHSS score at 24 hours were secondary outcomes.Symptomatic intracerebral haemorrhage(sICH)and bleeding events were safety outcomes.Primary analyses adjusted unbalanced baseline characteristics between treatments by multivariate logistic regression.Results A total of 719 patients were included:566 in anterior circulation stroke(ACS)and 153 in posterior circulation stroke(PCS).Primary outcome was 94.1%in DAPT and 91.7%in alteplase among ACS patients(adjusted risk difference(RD)and 95%CI,1.5%(−1.5%to 4.6%),p=0.32),while 91.2%in DAPT and 91.8%in alteplase among PCS patients(adjusted RD and 95%CI,−2.1%(−8.5%to 4.4%),p=0.53).Compared with alteplase,DAPT was associated with lower risk of sICH(p=0.03)and bleeding events(p<0.001)in ACS,but only lower risk of bleeding events(p=0.007)in PCS.Additionally,among ACS patients,the alteplase was superior to DAPT in terms of decrease in NIHSS score at 24 hours compared with admission(adjusted geometric mean ratio and 95%CI,−0.09(−0.16 to−0.03),p=0.005)and early neurological improvement(adjusted RD and 95%CI,−7.2%(−11.6%to−2.7%),p=0.001).Conclusion Among ischaemic stroke with minor non-disabling symptoms,DAPT was similar with intravenous alteplase regarding long-term functional outcome and better safety regardless of ACS or PCS.The potential benefit of intravenous alteplase regarding early neurological improvement in patients with ACS warrants further investigation.Trial registration number NCT03661411.
文摘Posterior circulation stroke may rarely be associated with occlusive disease in the anterior circulation, such as in the context of a direct （fetal） origin of the posterior cerebral artery （PCA） from the internal carotid artery （ICA）, or in the presence of a persistent trigeminal artery （PTA） or persistent hypoglossal artery （PHA）. Usually, they happened as infarction involving both ipsilateral carotid and posterior cerebral artery territories with carotid atherosclerosis etiology.3 Here, we reported a rare case with cadioembolic occlusion of the ICA presented with infarction mainly in the PCA territory.
