Screening Status And Prognosis Of Indications For Endovascular Therapy In Symptomatic Intracranial Atherosclerotic Disease

Objective: To evaluate the status and prognosis of multimodal neuroimaging screening before endovascular therapy in patients with symptomatic intracranial atherosclerotic disease(s ICAD)in the real world.Methods: Patients with anterior circulation s ICAD,who were treated in our hospital from January 2016 to May 2019,were included retrospectively.The admission criteria were proximal lesions of anterior circulation artery,stenosis rate?70%,baseline NIHSS score?20,pre disease m RS?2,standard medical therapy within 2 weeks after the onset or angioplasty within 3 months after the onset(including mechanical thrombectomy and bridging angioplasty within 24 hours after the onset).To study the application of multimodal neuroimaging technology before endovascular therapy in the real world,analyze the gap between the current situation and the guidelines of endovascular therapy screening;Evaluate the clinical prognosis of DWI combined with traditional angiographic screening in patients with watershed infarction;Compared with the patients treated with standard medical,the recurrence rate,bleeding and all-cause of stroke in 6 months and 1 year after enrollment in endovascular therapy group.Results: In this study,all the patients received structural imaging examinations such as NCCT/DWI/FLAIR and vascular imaging examinations such as TCD/MRA;Only 5.3% of the 38 endovascular patients received perfusion imaging such as ASL or CTP before surgery.Compared with patients in the standard medical therapy group,the recurrence rate of stroke in the endovascular therapy group were significantly reduced at 6 months and 1 year(0 vs 10.3%,P=0.045;2.8% vs 20.5%,P=0.011),and there was no significant difference in intracranial hemorrhage and all-cause mortality between the two groups(P>0.05).Among the watershed infarcts selected by DWI,the 1-year recurrence rate in the endovascular therapy group was significantly lower than that in the standard medical treatment group(0 vs 21.5%,P=0.035);The recurrence rate in the endovascular treatment and the standard medical treatment was similar in the non-watershed infarcts(P=0.342,P=0.182).Conclusions: The preoperative evaluation of cerebral perfusion in patients with endovascular therapy is not perfect;for patients with SICAD accompanied by severe stenosis or occlusion of intracranial artery and watershed infarction,brain DWI structure imaging combined with traditional vascular imaging can be used as the basis for the screening of indications for intravascular therapy,which is conducive to the screening of basic hospitals without perfusion imaging technology for the selection of patients with indications for endovascular therapy.