Clinical Research On Endovascular Recanalization Treatment Of Acute Ischemic Stroke With Intracranial Atherosclerosis Stenosis

Object: To investigate the effect of endovascular recanalization treatment of acute ischemic stroke(AIS)with intracranial atherosclerosis stenosis(ICAS).Methods: According to the inclusion and exclusion criterias,we selected the fifteen patients who received emergency endovascular recanalization treatment and with moderate or severe intracranial atherosclerosis stenosis(the degree of stenosis?50%)which were detected by digital subtraction angiography(DSA)in neurology department of 306 th hospital of PLA.We analyzed their clinical feature,imaging data,treatment and the prognosis of 90 days follow ups retrospectively.The effectiveness of the treatment was assessed through recanalization rate which were evaluated by modified thrombolysis in cerebral infarction(m TICI)after endovascular recanalization treatment,the National Institute of Health Stroke Scale(NIHSS)before and after treatment and the modified Rankin Scale(m RS)after 90 days.The surgery-related complications such as intracranial hemorrhage,artery dissection and so on and the mortality of patients were used to evaluate the safety of the treatment.Results: 1.The NIHSS at admission: the scores were from 6 to 31,the average score was(16±7).There were 6 patients with severe stroke(NIHSS scores 15-25)and 2 patients with very severe stroke(NIHSS scores >25).They accounted for 53.3%.2.Treatment modes: the 15 patients all received endovascular treatment,there were 8 patients who received intravenous thrombolytic therapy before endovascular treatment.About the modes of endovascular treatment,there were 4 patients received the drug therapy in the artery without further endovascular treatment,2 patients with emergency stenting,and the other 9 patients who received mechanical thrombectomy.Among the 9 patients,there were 2 patients were treated with balloon angioplasty also,2 patients were treated with emergency stenting,and one patient was treated with balloon angioplasty and implanted a stent electively.3.The surgery-related complications: one patient with asymptomatic intracranial hemorrhage,and 4 patients with symptomatic intracranial hemorrhage.The incidence of s ICH was 25%.No patient with artery dissection.4.The recanalization rate: m TICI 2b or 3 was achieved in 9 patients,the recanalization rate was 60%.5.Prognosis follow ups: there were 6 patients with a favorable outcome(40%)which defined as m RS?2 at 90 days.There were 7 patients with moderately severe disability(m RS 3-4)and one patient with severe disability(m RS 5).There was one patient who died,the mortality was 6.7%.6.Good prognosis was significantly related with recanalization(P=0.028).7.Good prognosis had a certain correlation with good collateral circulation.(P=0.044)Conclusion: There is no standard treatment protocols on the patients of acute ischemic stroke with intracranial atherosclerosis stenosis at present.There are many endovascular treatment methods,but the specific choice of treatment and how to combine a variety of treatment methods should be followed by the principle of individualization for restoring perfusion.Good prognosis may has a certain correlation with good collateral circulation.