This says something but I can't tell what.
Association of periprocedural perfusion non-improvement with recurrent stroke after endovascular treatment for Intracranial Atherosclerotic Stenosis
Abstract
Background:
Predictors
of recurrent stroke after endovascular treatment for symptomatic
intracranial atherosclerotic stenosis (ICAS) remain uncertain.
Objectives:
Among
baseline characteristics, lesion features, and cerebral perfusion
changes, we try to explore which factors are associated with the risk of
recurrent stroke in symptomatic ICAS after endovascular treatment.
Design:
Consecutive
patients with symptomatic ICAS of 70–99% receiving endovascular
treatment were enrolled. All patients underwent whole-brain computer
tomography perfusion (CTP) within 3 days before and 3 days after the
endovascular treatment. Baseline characteristics, lesion features, and
cerebral perfusion changes were collected.
Methods:
Cerebral
perfusion changes were evaluated with RAPID software and calculated as
preprocedural cerebral blood flow (CBF) < 30%, time to maximum of the
residue function (Tmax) > 6 s, and Tmax > 4 s volumes minus
postprocedural. Cerebral perfusion changes were divided into
periprocedural perfusion improvement (>0 ml) and non-improvement
(⩽ 0 ml). Recurrent stroke within 180 days was collected. The Cox
proportional hazards analysis analyses were performed to evaluate
factors associated with recurrent stroke.
Results:
From
March 2021 to December 2021, 107 patients with symptomatic ICAS were
enrolled. Of the 107 enrolled patients, 30 (28.0%) patients underwent
balloon angioplasty alone and 77 patients (72.0%) underwent stenting.
The perioperative complications occurred in three patients. Among
CBF < 30%, Tmax > 6 s, and Tmax > 4 s volumes, Tmax > 4 s
volume was available to evaluate cerebral perfusion changes.
Periprocedural perfusion improvement was found in 77 patients (72.0%)
and non-improvement in 30 patients (28.0%). Nine patients (8.4%)
suffered from recurrent stroke in 180-day follow-up. In Cox proportional
hazards analysis adjusted for age and sex, perfusion non-improvement
was associated with recurrent stroke [hazards ratio (HR): 4.472; 95% CI:
1.069–18.718; p = 0.040].
Conclusion:
In
patients with symptomatic ICAS treated with endovascular treatment,
recurrent stroke may be related to periprocedural cerebral perfusion
non-improvement.
Registration:
http://www.chictr.org.cn. Unique identifier: ChiCTR2100052925.
Introduction
Intracranial atherosclerotic stenosis (ICAS) is one of the most common causes of ischemic stroke worldwide.1–3
Patients with 70–99% symptomatic ICAS are at high risk of recurrent
stroke (12.2%) at 1 year despite aggressive medical management (AMM),4 and especially higher (37%) in those patients with impaired hemodynamics.5 Endovascular treatment remains an alternative therapy for patients with symptomatic ICAS refractory to AMM.6–8
In two recent multiple registries focusing on endovascular treatment
for symptomatic ICAS, the 1-year recurrent stroke declined to 6.3% and
8.5% compared with 20% in Stenting Versus Aggressive Medical Therapy for
Intracranial Atherosclerosis (SAMMPRIS) trial.9,10
So
far, the predictors of the risk of recurrent stroke after endovascular
treatment for symptomatic ICAS remain uncertain. We hypothesize that
some baseline characteristics, lesion features, or cerebral perfusion
parameters (preprocedural, postprocedural, or periprocedural changes)
might be related to the risk of recurrent stroke after endovascular
treatment. As for the evaluation of cerebral perfusion parameters, RAPID
software (iSchemia View) which is an automatic software for
post-processing computer tomography perfusion (CTP) images can
quantitatively evaluate cerebral perfusion parameters, and it had been
used to identify potential beneficiary with acute large vessel occlusion
through endovascular thrombectomy.11,12 Furthermore, RAPID software was used to assess impaired perfusion for patients with ICAS.13
In
this study, we collected baseline characteristics, lesion features, and
preprocedural and postprocedural cerebral perfusion parameters of
patients with symptomatic ICAS treated with endovascular therapy in a
high-volume stroke center and evaluated which factors were associated
with the 180-day outcome of recurrent stroke.
No comments:
Post a Comment