Multi-modal revascularization for acute ischemic stroke caused by intracranial vascular occlusion

Abstract

Objective To investigate the effectiveness and safety of multi ? modal endovascular treatment on acute ischemic stroke caused by intracranial vascular occlusion.  Methods Sixteen cases with acute ischemic stroke were studied, within which 4 cases were found respectively with left and right internal carotid artery (ICA) ophthalmic artery (OA) segment embolism (4/16), 4 cases were found occlusion at left M1 segment of middle cerebral artery (MCA, 4/16), one case was found occlusion at left M2 segment of MCA (1/16), 3 cases were found occlusion at right M1 segment of MCA (3/16), 3 cases were found occlusion at bifurcation of left anterior cerebral artery (ACA) and MCA (3/16), and one case was found atherosclerotic stenosis with thrombosis at middle and lower segment of basal artery (BA, 1/16). They underwent multi? modal endovascular treatment, including thrombus aspiration, mechanical thrombectomy, intra-arterial thrombolysis, balloon dilatation and stent implantation. The Thrombolysis in Cerebral Infarction (TICI) was used to evaluate the recanalization immediately after operation. National Institutes of Health Stroke Scale (NIHSS) was used to evaluate neurological function on admission and 21 d after operation, and modified Rankin Score (mRS) was used to evaluate the prognosis 3 months after treatment. Postoperative complications were recorded.  Results Complete recanalization was found in 6 cases (6/16, TICI 3), 8 cases were found partial recanalization (TICI 2, 8/16), including TICI 2a in one case (1/16) and TICI 2b in 7 cases (7/16), and no recanalization was found in other 2 cases (TICI 0-1, 2/16). NIHSS score 21 d after operation was significantly lower than that on admission [12.50 (6.75, 19.25) score vs. 18.00 (13.25, 21.50) score; Z = ? 2.287, P = 0.022]. Followed?up for 3 months, mRS score was 1 in 2 cases (2/16), 2 in 4 cases (4/16), 3 in 5 cases (5/16), 4 in 2 cases (2/16), 5 in 2 cases (2/16) and 6 in one case (1/16). Postoperative complications included 2 cases of pulmonary infection (2/16), one case of gum bleeding (1/ 16), and 3 cases of hemorrhagic transformation (HT) of ischemic stroke (3/16), including 2 cases of hemorrhagic infarction (HI2, 2/16) and one case of parenchymal hematoma (PH1, 1/16).  Conclusions Multi?modal endovascular treatment, including thrombus aspiration, mechanical hrombectomy, intra?arterial thrombolysis, balloon dilatation and stent implantation, is safe and effective for treating acute ischemic stroke, and can significantly improve the life quality of patients.

DOI: 10.3969/j.issn.1672-6731.2018.05.010