Management of intervenable factors to reduce vascular complications in patients with internal carotid artery occlusion treated by non-emergency endovascular treatment.

Objective: This study aims to identify risk factors for vascular complications during non-emergency endovascular treatment in patients with internal carotid artery occlusion (ICAO) and to propose potential interventions. Method: A retrospective analysis of 92 patients with ICAO who received non-emergency endovascular treatment in our center from 1 January 2018 to 31 June 2023, was conducted. The correlation between intraoperative vascular complications and potential risk factors was studied, and interaction analysis was performed. Results: Our findings revealed that the use of non-neurology guide wires to open vessels (adjusted OR: 4.1, 95%CI: 1.3-12.8; p = 0.014) and glycosylated hemoglobin (HbA1c) ≥ 6.5 mmol/L (adjusted OR: 3.2, 95%CI: 1.2-8.9; p = 0.023) was significantly associated with vascular complications in non-emergency endovascular treatment of ICAO patients. The restricted cubic spline (RCS) showed that the higher the HbA1c level, the higher the risk of vascular complications. Conclusion: The use of non-neurology guide wires for vessel opening during non-emergency endovascular treatment in patients with ICAO increases the risk of vascular complications. Preoperative assessment and management of HbA1c levels can reduce the incidence of intraoperative vascular complications.

Endovascular recanalization for symptomatic subacute and chronically occluded internal carotid artery: feasibility, safety, a modified radiographic classification system, and clinical outcomes.

PURPOSE: To evaluate the feasibility and safety of endovascular recanalization for symptomatic subacute and chronic internal carotid artery occlusion (ICAO); to propose a newly modified radiographic classification of ICAO that can rigorously identify suitable candidates for endovascular ICAO treatment. METHODS: We included 42 consecutive patients who had ICAO with ischaemic symptoms refractory to medical therapy. We examined the symptomatology, complications, follow-up results and radiographic images of ICAO receiving attempted endovascular treatment. We attempted to stratify all radiographic images into categories based on morphological occlusion patterns, occlusion segments and distal ICA reconstitution on digital subtraction angiography (DSA). RESULTS: Four types (A-D) of radiographic ICAO were identified. We redefined type B as having a tapered stump but no distal lumen. The rate of successful recanalization was 83.33% (35/42 ICAOs; type A, 18/20; type B, 7/10; type C, 10/11; type D, 0/1). The perioperative complication rate was 11.90% (5/42), including 3 asymptomatic distal embolisms, 1 symptomatic cerebral infarction and 1 asymptomatic carotid artery dissection. None of these technique-related complications led to severe neurological damage or death. Modified Rankin Scale (mRS) scores after 1-20 months of follow-up were significantly decreased in successfully revascularized patients (P < 0.001). There was no significant change in mRS scores in the 7 patients in whom recanalization failed (P > 0.05). CONCLUSIONS: Endovascular recanalization seems to achieve technical success and clinical improvement for symptomatic subacute and chronic ICAO. Additionally, our newly modified radiographic classification of ICAO may be valuable in assessing the technical feasibility and safety of procedures in symptomatic ICAO patients.

A Review on the Comparison of Different Treatments for Carotid In-Stent Restenosis.

Different treatment options for carotid in-stent restenosis (ISR) have been reported with good outcome, including carotid endarterectomy (CEA), repeated carotid angioplasty stenting (CAS) and percutaneous transluminal angioplasty (PTA) with drug-coated balloons (DCBs). However, the optimal treatment option for ISR has not yet been determined. A systematic literature search was performed in the databases of Medline, Embase, Cochrane library, and unpublished data from clinicaltrials.gov from 1990 to March 1, 2019. Studies were enrolled if they reported treatment strategies for carotid ISR treatment and met the inclusion criteria. After study inclusions, data were extracted and summarized. Totally 25 cross-sectional studies were included, containing 5 comparative studies, 16 studies using repeated PTA, and 4 studies adopting CEA treatment. Our study summarized the current available data, showing that all the studies could effectively relieve the carotid ISR by significantly improving the angiographic stenosis and decreasing the peak systolic velocity values. Meanwhile, CEA treatment had the best long-term effects in relieving restenosis, while re-PTA with stenting/balloon angioplasty had a certain rate of restenosis, ranging from 33% to 83%. Furthermore, re-PTA/stenting and balloon angioplasty treatment had less complications compared with CEA. Also, we analyzed the risk factors that might affect the long-term prognosis of carotid ISR patients. The therapeutic measures for carotid ISR had their own features, with CEA had the highest efficacy while re-PTA/stenting and balloon angioplasty were with less complications. More large-scale comparative clinical studies are needed to further ascertain the best strategies.

Examen comparatif entre divers traitements de la resténose carotidienne sous-tendant la pose d'endoprothèses. Dans le cas de la resténose carotidienne, la littérature scientifique signale différentes possibilités de traitement sous-tendant la pose d'endoprothèses (stents). Ces traitements s'accompagnent de bons résultats et incluent l'endartériectomie carotidienne, l'angioplastie répétée et l'angioplastie percutanée transluminale au moyen de ballonnets actifs (drug-coated balloons). Cela dit, on n'est pas encore parvenus à déterminer une possibilité idéale de traitement. Nous avons effectué une recension systématique de la littérature scientifique au moyen des bases de données suivantes : MEDLINE, Embase et Cochrane Library. Nous avons également fait appel à des données jamais publiées tirées du site Internet clinicaltrials.gov et comprises entre l'année 1990 et le 1er mars 2019. Pour notre propos, nous avons retenu des études si elles satisfaisaient à nos critères d'inclusion et si elles faisaient état de stratégies de traitement destinées à la resténose carotidienne et sous-tendant la pose d'endoprothèses. Nous avons ensuite extrait de ces études des données et les avons résumées. Un total de 25 études transversales a été inclus : 5 d'entre elles étaient de nature comparative ; 16 portaient sur l'angioplastie répétée ; et 4 portaient sur l'endartériectomie carotidienne. Notre étude a résumé les données actuelles disponibles et a montré, en nous fondant sur ces études précédentes, qu'il était possible atténuer de manière efficace la resténose carotidienne en améliorant de manière notable la technique angiographique de la sténose et en diminuant les valeurs maximales de tension systolique. En parallèle, on a noté que l'endartériectomie carotidienne était le traitement procurant les meilleurs résultats à long terme en ce qui concerne la resténose tandis que l'angioplastie percutanée transluminale au moyen de ballonnets actifs comportait toujours un certain taux de resténose variant entre 33 et 83 %. Plus encore, il convient de préciser que l'angioplastie percutanée transluminale avec ou sans ballonnets actifs entraînait moins de complications en comparaison avec l'endartériectomie carotidienne. Enfin, nous avons analysé les facteurs de risque pouvant affecter le pronostic à long terme des patients atteints de resténose carotidienne. Les mesures thérapeutiques destinées à la resténose carotidienne comportaient toutes leurs propres caractéristiques, l'endartériectomie carotidienne étant la plus efficace alors que l'angioplastie percutanée transluminale avec ou sans ballonnets actifs entraînait moins de complications. Chose certaine, des études cliniques comparatives de plus grande envergure demeurent nécessaires afin de déterminer quelles sont les meilleures stratégies.

[Correlation of collateral circulation and prognosis in patients with acute cerebral infarction].

OBJECTIVE: To evaluate the correlation of collateral circulation with prognosis in patients with acute cerebral infarction. METHODS: A total of 260 patients with acute ischemic stroke within 1 week of symptom onset underwent digital subtraction angiogram (DSA). The National Institutes of Health Stroke Scale (NIHSS) scores were obtained at admission. And the Modified Rankin scores (mRS) were assessed at a 3-month follow-up. The follow-up data were acquired through clinic visits or telephone interviews. RESULTS: Among them, 86 were found to have intra- or extra-cranial culprit artery severe stenosis or occlusion. And 36 (75.00%) in 48 patients had collateral arterial circulation while 11 (28.64%) in 38 patients posterior circulation. There were statistical differences in the NIHSS scores at admission and favorite clinical outcome (mRS ≤ 2) at 3-month follow-up for patients with and without collateral circulation. CONCLUSION: DSA is the golden standard for the assessment of collateral circulation in patients with severe cerebral artery stenosis or occlusion. The prognosis is better in stroke patients with collateral circulation.

Clinical study of PTAS therapy for patients with ischemia cerebrovascular disease caused by artery stenosis.

The curative efficacy of percutaneous transluminal angioplasty and stenting (PTAS) in the treatment of patients with ischemia cerebrovascular disease caused by artery stenosis was explored. The clinical data of 111 patients with ischemia cerebrovascular disease receiving PTAS in Guangdong Province General Hospital from Aug. 2007 to Nov. 2009 were retrospectively analyzed. In total 132 stents were implanted in the 111 patients. The mortality and rate of neural and non-neural complications were assessed perioperatively. Outcomes [including the frequency of transient ischemic attack (TIA), stroke, or death from vascular diseases) were assessed after operation. NIHSS rating was performed in all cases before and at first week, 6th month and 12th month after the operation. The PTAS success rate was 100%. The degree of stenosis was reduced after PTAS. The total complication rate during perioperative period was 15.3% (the rate of neural complications was 3.6%). Sixty-seven patients were followed up. Three patients (4.48%) developed cerebrovascular events within 1 month, containing one case of TIA, one case of ipsilateral mild stroke and one case of contralateral mild stroke. No severe stroke or death was observed. During a follow-up period of 12 months 7 patients had cerebrovascular events (10.44%), including 2 cases of ipsilateral TIA (2.99%), 2 cases of ipsilateral mild stroke and 2 cases of contralateral mild stroke (2.99%), one case of severe stroke (1.49%). In 13 patients receiving DSA re-examination one year after PTAS, 2 patients (15.38%) had in-stent restenosis. NIHSS scores were obviously decreased during a follow-up period as compared with those pre-operation (P<0.05). It was concluded that PTAS could significantly alleviate the neural function deficit of the patients with ischemia cerebrovascular disease. The success rate of PTAS was high, and the rate of complications was lower and the clinical outcomes were satisfactory. PTAS is a safe and effective therapeutic method, though the long-term outcomes need further study.

Clinical Study of PTAS Therapy for Patients with Ischemia Cerebrovascular Disease Caused by Artery Stenosis / 华中科技大学学报（医学）（英德文版）

The curative efficacy of percutaneous transluminal angioplasty and stenting (PTAS) in the treatment of patients with ischemia cerebrovascular disease caused by artery stenosis was explored.The clinical data of 111 patients with ischemia cerebrovascular disease receiving PTAS in Guangdong Province General Hospital from Aug.2007 to Nov.2009 were retrospectively analyzed.In total 132 stents were implanted in the 111 patients.The mortality and rate of neural and non-neural complications were assessed perioperatively.Outcomes [including the frequency of transient ischemic attack (TIA),stroke,or death from vascular diseases) were assessed after operation.NIHSS rating was performed in all cases before and at first week,6th month and 12th month after the operation.The PTAS success rate was 100％.The degree of stenosis was reduced after PTAS.The total complication rate during perioperative period was 15.3％ (the rate of neural complications was 3.6％).Sixty-seven patients were followed up.Three patients (4.48％) developed cerebrovascular events within 1 month,containing one case of TIA,one case of ipsilateral mild stroke and one case of contralateral mild stroke.No severe stroke or death was observed.During a follow-up period of 12 months 7 patients had cerebrovascular events (10.44％),including 2 cases of ipsilateral TIA (2.99％),2 cases of ipsilateral mild stroke and 2 cases of contralateral mild stroke (2.99％),one case of severe stroke (1.49％).In 13 patients receiving DSA re-examination one year after PTAS,2 patients (15.38％) had in-stent restenosis.NIHSS scores were obviously decreased during a follow-up period as compared with those pre-operation (P＜0.05).It was concluded that PTAS could significantly alleviate the neural function deficit of the patients with ischemia cerebrovascular disease.The success rate of PTAS was high,and the rate of complications was lower and the clinical outcomes were satisfactory.PTAS is a safe and effective therapeutic method,though the long-term outcomes need further study.