Clinical Registry Study On Endovascular Therapy For Acute Ischemic Stroke In Patients With Internal Carotid Artery Occlusion

Background and AimsAcute internal carotid artery occlusion is one of the most devastating occasions,which represents 6%to 15%in acute ischemic stroke.Recent randomized trials have proved the safety and effectiveness of endovascular treatment for anterior intracranial proximal artery occlusion.However,the proportion of patients with acute carotid occlusion concurs between 13%and 44.1%in these studies.The efficacy and safety of endovascular treatment on acute internal carotid occlusion are different in several case series reports.The underlying etiologies of carotid artery occlusion are too much complicate to make accurate judgment of the lesion pattern,such as atherosclerosis,thromboembolic or artery dissection,may challenge recanalization of the target artery.Overall,our study includes three parts:(1)Part 1 aimed to investigate the effectiveness and safety of endovascular treatment for acute ICA occlusion,and to identify clinical factors associated with favorable outcome.(2)Part 2 aimed to investigate the effectiveness and safety of endovascular treatment for acute carotid tandem occlusion,and to compare outcomes following emergency EICA treatment(stenting versus angioplasty alone)subsequent with intracranial SRT.(3)Part 3 aimed to identify predictors of SAP in patients underwent intra-arterial treatment.Patient and methodStudy population:A series of consecutive patients with acute ICA occlusion who received endovascular intervention at our center between January 2012 and June 2016 were included.Clinical data(1)Baseline and clinical characteristics;(2)Admission NIHSS score,ASPECT score,et al;(3)ASITN/SIR score and mTICI;(4)Key time intervals between onset to treatment,endovascular procedure and complications;(5)follow up records.StatisticsWe used the Statistical Product and Service Solutions(SPSS,IBM Corporation,Armonk,New York,USA)program(version 18)to analyze the data.Results are expressed as percentages for categorical variables and as means(standard deviation(SD))and medians(interquartile ranges(IQRs))for the continuous variables,and absolute numbers and percentages for nominal and categorical variables depending on the normal or nonnormal distribution of data.We performed a chi-square test to determine the correlation between categorical variables,a t-test between continuous variables,and a Mann-Whitney test between scores.Adjusted logistic regression was carried out to estimate the odds ratios(ORs).All variables with a P value less than 0.05 were entered into the logistic regression model.In order to study the ability of SAP for mortality prediction,we calculated Kaplan-Meier survival curves and compared by the log-rank test.We reported hazard ratios(HRs).A P value less than 0.05 was considered as significant.ResultsPart onePatients who receive endovascular therapy with acute ICA occlusion.Univariate analysis and multivariate logistic regression analysisYounger age,atrial fibrillation,cardio embolism,admission NIHSS score and 24h,lower incidence of sICH,and good reperfusion were significant difference between two groups in univariable analysis.Multivariate logistic regression analysis revealed that the good reperfusion(mTICI>2b,odds ratio[OR]= 0.149,95%confidential interval[CI]:0.038-0.578)and lower NIHSS score after 24h(OR=1.007;95%CI 1.007-1.217)were independently associated with favorable outcome.Part twoPatients who receive endovascular therapy with acute anterior tandem occlusions.Comparisons of baseline characteristics and outcomes between Stenting and Angioplasty-alone GroupsThere were no differences in demographic data,admission NIHSS score,baseline ASPECTS,collateral status,number of stentriever passes,distal embolization,onset to recanalization time and puncture to final recanalization time between stenting and angioplasty alone Groups.Successful recanalization rate was higher in stenting group than in angioplasty alone group.And the proportions of patients with favorable outcomes in two groups were similar.The rate of sICH,cerebral herniation and mortality did not differ between stenting group and angioplasty alone group.Part threeThe risk factor of SAP in AIS patients with intra-arterial treatmentAge,NIHSS score,GCS score,duration time of operation and symptom of dysphagia,was significantly associated with SAP in patients with AIS with IAT.Only symptom of dysphagia(adjust OR,12.051;95%CI,3.457-50.610;P<0.001)and total time of operation(adjust OR,1.040;95%CI,1.009-1.071;P<0.001)were identified as independent predictors of SAP.ConclusionsPart one:Endovascular intervention of acute ICA occlusion was technically feasible and resulted in high revascularization rate.A trend for favorable outcome was seen in a higher mTICI score and lower NIHSS score after 24h.Part two:Management of acute anterior tandem occlusions with endovascular therapy was safety and effectiveness.Our study suggests that patients undergoing SRT with EICA stenting in the setting of acute tandem occlusion seems to achieve higher recanalization and tend to obtain improved clinical outcome at 3months compared to those undergoing angioplasty alone.The rates of sICH and mortality are comparable.Part three:Total time of operation is a risk factor of stroke-associated pneumonia in acute ischemic stroke patients with intra-arterial treatment.