背景

血管内治疗(EVT)中同侧颅外颈内动脉(ICA)狭窄的最佳管理尚不清楚。我们比较了两种不同策略的结果：有无颈动脉支架置入术(CAS)的EVT。

方法

在这项观察性研究中，我们纳入了荷兰急性缺血性卒中血管内治疗多中心随机临床试验(MR CLEAN)(2014-2017)中接受EVT并伴有同侧颅外ICA狭窄50%或推测动脉粥样硬化来源闭塞的急性缺血性卒中患者。

主要终点为90天的良好功能结局，定义为改进的Rankin量表评分;次要终点是成功的颅内再灌注，不同血管区域的新血栓，有症状的颅内出血，复发性缺血性中风和任何严重的不良事件。

结果

在纳入的433例患者中，169例(39%)接受了伴随CAS的EVT。在123/168(73%)例患者中，CAS在颅内取栓前进行。在42/224(19%)未接受CAS的EVT患者中，行延期颈动脉内膜切除术(CAS)。有和没有CAS的EVT与良好功能结局的比例相似(分别为47% vs42%;调整OR (aOR)，0.90;95%Cl, 0.50 ~ 1.62)。两组在任何次要终点上均无重大差异，除了EVT与CAS组在不同血管区域出现新血栓的几率增加(aOR, 2.96;95% CI, 1.07 ~ 8.21)。

结论

有无CAS的EVT后功能结局具有可比性。EVT期间的CAS可能是治疗颅外ICA狭窄的可行选择，但需要进行随机研究来证明非劣效性或优越性。

BACKGROUND: The optimal management of ipsilateral extracranial internal carotid artery (ICA)stenosis during endovascular treatment (EVT)is unclear. We compared the outcomes of two different strategies: EVT with vs without carotid artery stenting (CAS).
METHODS: In this observational study, we included patients who had an acute ischaemic stroke undergoing EVT and a concomitant ipsilateral extracranial ICA stenosis of ≥50% or occlusion of presumed atherosclerotic origin, from the Dutch Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry(2014-2017). The primary endpoint was a good functional outcome at 90 days, defined as a modified Rankin Scale score ≤2. Secondary endpoints were successful intracranial reperfusion,new clot in a different vascular territory,
symptomatic intracranial haemorrhage, recurrent ischaemic stroke and any serious adverse event.
RESULTS: Of the 433 included patients, 169(39%) underwent EVT with CAS. In 123/168 (73%)patients, CAS was performed before intracranial thrombectomy. In 42/224(19%) patients who underwent EVT without CAS, a deferred carotid endarterectomy or CAS was performed. EVT with and without CAS were associated with similar proportions of good functional outcome (47% vs42%, respectively; adjusted OR (aOR), 0.90; 95%Cl, 0.50 to 1.62). There were no major differences between the groups in any of the secondary endpoints, except for the increased odds of a new clot in a different vascular territory in the EVT with CAS group (aOR, 2.96; 95% CI, 1.07 to 8.21).
CONCLUSIONS: Functional outcomes were comparable after EVT with and without CAS. CAS during EVT might be a feasible option to treat the extracranial ICA stenosis but randomised studies are warranted to prove non-inferiority or superiority.