Endovascular Treatment for Acute Posterior Circulation Stroke with Large Vessel Occlusion: A Single-center Case Series Report

doi:10.3969/j.issn.1673-5765.2023.10.005

Abstract

Abstract: Objective To evaluate the safety and effectiveness of endovascular treatment (EVT) for acute posterior circulation stroke with large vessel occlusion.
Methods Patients within 72 hours with acute posterior circulation stroke due to large vessel occlusion who underwent emergency EVT in Beijing Daxing District People's Hospital from September 2020 to March 2023 were included. Demographic information, past history, baseline blood pressure, TOAST classification, admission and preoperative NIHSS score, onset to treatment time and in-hospital treatment information were collected. The effectiveness outcome included postoperative mTICI grading (defined as vascular recanalization at 2b/3), NIHSS score at 24 h after surgery and at discharge, mRS score at discharge (0 to 3 scores defined as good prognosis). The safety outcome included the incidence of symptomatic intracranial hemorrhage (sICH) within 36 h and mortality during hospitalization.
Results A total of 26 patients with acute posterior circulation stroke with large vessel occlusion were included (7 patients in the intravenous thrombolysis bridging EVT group and 19 in direct EVT group). 16 patients (62%) were male, and 10 patients (38%) were female. The mean age was (64.2±11.1) years old. Successful recanalization was observed in 25 patients (96%). The
24 h-NIHSS score at postoperation was 8.0(3.0-14.0) [the intravenous thrombolysis bridging EVT group 3.0(2.0-12.5) versus direct EVT group 8.0(4.3-16.3)]. 16 patients (62%) had good prognoses at discharge. 3 patients (12%) died, and no sICH occurred.
Conclusions EVT could effectively achieve successful reperfusion in acute posterior circulation stroke with large vessel occlusion, which showed good security.

Key words: Posterior circulation stroke; Large vessel occlusion; Endovascular treatment

摘要： 目的评估后循环急性大血管闭塞性卒中血管内治疗（endovascular treatment，EVT）的安全性和有效性。
方法回顾性连续入组2020年9月—2023年3月在北京市大兴区人民医院接受急诊EVT的发病72 h内的后循环急性大血管闭塞性卒中住院患者。收集患者的人口学信息、既往史、基线血压、TOAST分型、入院及术前NIHSS评分、发病至治疗时间及院内治疗信息等资料。疗效结局包括术后mTICI分级（将2b/3级定义为血管再通）、术后24 h和出院时NIHSS评分及出院时mRS评分（0～3分定义为预后良好）。安全性结局采用发病36 h内症状性颅内出血发生率及住院期间死亡率。
结果共纳入26例接受急诊EVT的后循环急性大血管闭塞性卒中患者（静脉溶栓桥接EVT组7例，直接EVT组19例），其中男性16例（62%），女性10例（38%），年龄（64.2±11.1）岁。25例（96%）患者术后血管成功再通，术后24 h NIHSS评分为8.0（3.0～14.0）分[静脉溶栓桥接EVT组3.0（2.0～12.5）分；直接EVT组8.0（4.3～16.3）分]。共16例（62%）患者出院时获得良好预后，3例（12%）患者发生死亡，所有患者均未发生症状性颅内出血。
结论 EVT能够有效实现后循环急性大血管闭塞性卒中的血管再灌注，安全性良好。

关键词: 后循环卒中; 大血管闭塞; 血管内治疗

YIN Mengxin, ZHANG Shuting, REN Weichao, WANG Tiejun, DUAN Chunmiao. Endovascular Treatment for Acute Posterior Circulation Stroke with Large Vessel Occlusion: A Single-center Case Series Report[J]. Chinese Journal of Stroke, 2023, 18(10): 1129-1135.

尹梦鑫, 张舒婷, 任伟超, 王铁军, 段春苗. 后循环急性大血管闭塞性卒中的血管内治疗：单中心病例系列报道[J]. 中国卒中杂志, 2023, 18(10): 1129-1135.

References

[1] Writing Group for the BASILAR Group，ZI W J，QIU Z M，et al. Assessment of endovascular treatment for acute basilar artery occlusion via a nationwide prospective registry[J]. JAMA Neurol，2020，77（5）：561-573.
[2] LIU X F，DAI Q L，YE R D，et al. Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion（BEST）：an open-label，randomised controlled trial[J]. Lancet Neurol，2020，19（2）：115-122.
[3] LANGEZAAL L C M，Van Der HOEVEN E J R J，MONT’ALVERNE F J A，et al. Endovascular therapy for stroke due to basilar-artery occlusion[J]. N Engl J Med，2021，384（20）：1910-1920.
[4] JOVIN T G，LI C H，WU L F，et al. Trial of thrombectomy 6 to 24 hours after stroke due to basilar-artery occlusion[J]. N Engl J Med，2022，387（15）：1373-1384.
[5] TAO C R，NOGUEIRA R G，ZHU Y Y，et al. Trial of endovascular treatment of acute basilar-artery occlusion[J]. N Engl J Med，2022，387（15）：1361-1372.
[6] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志，2018，51（9）：666-682.
Chinese Society of Neurology，Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chin J Neurol，2018，51（9）：666-682.
[7] ZAIDAT O O，YOO A J，KHATRI P，et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke：a consensus statement[J]. Stroke，2013，44（9）：2650-2663.
[8] HACKE W，KASTE M，BLUHMKI E，et al. Thrombolysis with alteplase 3 to 4. 5 hours after acute ischemic stroke[J]. N Engl J Med，2008，359（13）：1317-1329.
[9] TAO C R，QURESHI A I，YIN Y M，et al. Endovascular treatment versus best medical management in acute basilar artery occlusion strokes：results from the ATTENTION multicenter registry[J]. Circulation，2022，146（1）：6-17.
[10] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组，中华医学会神经病学分会神经血管介入协作组. 中国急性缺血性卒中早期血管内介入诊疗指南2022[J]. 中华神经科杂志，2022，55（6）：565-580.
Chinese Society of Neurology，Chinese Stroke Society，Neurovascular Intervention Group of Chinese Society of Neurology. Chinese guidelines for the endovascular treatment of acute ischemic stroke 2022[J]. Chin J Neurol，2022，55（6）：565-580.
[11] YE G F，LU J，QI P，et al. Firstline a direct aspiration first pass technique versus firstline stent retriever for acute basilar artery occlusion：a systematic review and meta-analysis[J]. J Neurointerv Surg，2019，11（8）：740-746.
[12] POWERS W J，RABINSTEIN A A，ACKERSON T，et al. Guidelines for the early management of patients with acute ischemic stroke：2019 update to the 2018 guidelines for the early management of acute ischemic stroke：a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J/OL]. Stroke，2019，50（12）：e344-e418[2023-01-01]. https://doi.org/10.1161/STR.0000000000000211.

[1]	FAN Yuhua, DANG Chao, YU Jian, CHEN Hongbing, DUAN Jiangang, MO Dapeng, ZHU Wenhao, OUYANG Fubing, WANG Bo, ZENG Jinsheng, the Writing Committee of Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases. Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases (Second Edition) (Excerpt)——Chapter Seven Clinical Management of Cerebral Venous Thrombosis [J]. Chinese Journal of Stroke, 2023, 18(9): 1030-1035.
[2]	LU Jing, LI Chuanfa, ZHANG Daqi, CHEN Rong, LI Qifu. Research Progress of Hemorrhagic Transformation after Endovascular Treatment in Acute Ischemic Stroke [J]. Chinese Journal of Stroke, 2023, 18(9): 1065-1072.
[3]	WEI Na, LIU Xin, NIE Ximing, YAN Hongyi, WEN Miao, YANG Zhonghua, LIU Liping. Effect of Collateral Status on Futile Recanalization after Endovascular Treatment in Patients with Acute Anterior Circulation Large Vessel Occlusive Cerebral Infarction [J]. Chinese Journal of Stroke, 2023, 18(04): 450-455.
[4]	GUAN Qiaochu, XIE Ziyi, LYU Weiping, NI Huanyu, LI Jingwei, ZHOU Junshan, YUN Wenwei, LI Xiaobo, ZHANG Qingxiu, XU Yun. A Comparative Study on the Efficacy and Safety of Bridging Therapy and Direct Endovascular Therapy for Acute Posterior Circulation Large Vessel Occlusive Cerebral Infarction [J]. Chinese Journal of Stroke, 2023, 18(04): 456-462.
[5]	LIU Chengchun, TANG Chunhua, HUANG Shuhan, WU Ya, LI Xiaoshu, LI Wei, ZHANG Meng. Emergent Management of Anterior Circulation Tandem Occlusion with Large Core Infarction [J]. Chinese Journal of Stroke, 2022, 17(08): 834-839.
[6]	CUI Xiaoyu, NIE Ximing, LIU Liping. Correlation of Hypoprealbuminemia and Outcome after Endovascular Treatment for Acute Ischemic Stroke [J]. Chinese Journal of Stroke, 2022, 17(07): 758-763.
[7]	HUO Xiaochuan, LI Xiaoqing, MIAO Zhongrong, Expert Committee for Neurointervention Quality Control of National Center for Healthcare Quality Management in Neurological Diseases, Endovascular Treatment Working Committee of National Action for Quality Improvement of Acute Cerebral Infarction Reperfusion Therapy. A Survey of Current Practice in Acute Ischemic Stroke Endovascular Treatment in China in 2020 [J]. Chinese Journal of Stroke, 2022, 17(01): 56-65.
[8]	LIU Fude, CHEN Chen, SONG Wenfeng, YUAN Xingyun, HAN Jianfeng, WANG Jianyi. Comparative Efficacy and Safety of RECO Flow Restoration Device versus Solitaire Stent for Acute Large Vessel Occlusion in Anterior Circulation [J]. Chinese Journal of Stroke, 2021, 16(12): 1229-1234.
[9]	SUN Da-Peng, HUO Xiao-Chuan, MA Gao-Ting, TONG Xu, ZHANG Xue-Lei, MIAO Zhong-Rong. vProgress of Automated Computed Tomography Perfusion in Endovascular Treatment for Acute Large Vessel Occlusion [J]. Chinese Journal of Stroke, 2021, 16(11): 1092-1098.
[10]	CAI Dong-Yang, YANG Bo-Wen, ZHAO Tong-Yuan, XU Gang-Qin, XUE Jiang-Yu, LI Tian-Xiao. Stump Morphology and Recanalization of Chronic Long Segment Occlusion in Internal Carotid Artery [J]. Chinese Journal of Stroke, 2021, 16(10): 990-995.
[11]	LIU Ting, LIAO Juan, LIU Li, ZHAO Li-Bo, LIU Shu-Dong, XU Lu, ZHOU Ting, YANG De-Yu. Analysis on the Predictive Value of Modified Cincinnati Prehospital Stroke Severity Scale for Acute Large Vessel Occlusion in Anterior Circulation [J]. Chinese Journal of Stroke, 2021, 16(07): 687-693.
[12]	HE Yi-Xuan, WANG Bing, DENG Jian-Ping, YU Jia, ZHAO Zhen-Wei. Analysis of the Efficacy of Endovascular Treatment of Paraclinoid Unruptured Intracranial Aneurysms [J]. Chinese Journal of Stroke, 2021, 16(06): 551-555.
[13]	LI Xiao-Qing, GAO Yuan, GAO Feng. Exploring the Efficacy of Training Model of Endovascular Treatment for Acute Ischemic Stroke [J]. Chinese Journal of Stroke, 2021, 16(06): 635-637.
[14]	LI Guang-Wen, LIU Peng, GONG Wen-Tao, LIU Tong-Hui, SUN Yu-Jie, ZHANG Xian-Jun, ZHANG Yong. Analysis of Feasibility of Endovascular Therapy for Non-acute Intracranial Anterior Circulation Large Vessel Occlusion [J]. Chinese Journal of Stroke, 2021, 16(04): 348-353.
[15]	ZHANG Zhe, PU Yue-Hua, YU Lei, DUAN Wan-Ying, MI Dong-Hua,LIU Li-Ping. The Association of Cerebral Autoregulation Function after Endovascular Treatment with Clinical Outcome in Acute Anterior Circulation Ischemic Stroke [J]. Chinese Journal of Stroke, 2020, 15(12): 1299-1305.