The Value Of Endovascular Recanalization For Non-acute Large Artery Occlusion With Impaired Anterior Circulatory Perfusion

Objective:To investigate the improvement in imaging and clinical symptoms of endovascular recanalization for non-acute large artery occlusion(NALAO)with impaired anterior circulation perfusion and to evaluate the safety and efficacy of endovascular opening therapy in multiple dimensions.Methods:Hunan patients with NALAO diagnosed with impaired anterior circulation perfusion using preoperative CT examinations in Hunan Provincial People’s Hospital between January 2020 and February 2021 were included in the study.All patients were treated with endovascular recanalization.Multimode imaging and neurology scales were compared pre-and postoperatively to explore the safety and effectiveness of the treatment.Results:A total of 13 patients participated in the study,including six cases with middle cerebral artery occlusion(MCAO)and seven cases with internal carotid artery occlusion(ICAO).Eleven patients underwent successful operations.The success rate of endovascular recanalization was 84.62%.Surgery failed in two patients,including one with Moyamoya disease in the distal trunk of the occluded vessel and one with difficulty in identifying the true lumen.Perioperative complications occurred in six patients,including three cases of vascular dissection.One patient developed a stress ulcer within 24 h,and two patients had a hemorrhagic transformation.No serious adverse events or deaths occurred during perioperative or follow-up periods.Preoperative CTP showed that the difference in CBF,MTT,and TTP between the affected and healthy sides was statistically significant(CBF: 47.24 ± 10.45 m L/(100 g·min)vs.59.52 ± 5.36 m L/(100 g·min),P<0.01;MTT: 5.88 ± 1.13 m L/100 g vs.3.99 ± 0.49 m L/100 g,P<0.01;TTP: 15.47 ± 3.19 s vs.12.15 ± 2.11 s,P<0.01).The neurological deficits 30 and 90 days after the operation were improved(NIHSS grade: 4(1,10)vs.2(1,6)P<0.05;2(1,6)vs.2(0.5,5)P<0.05).The m RS(46.15% vs.76.92%)and MMSE grade(20.56 ± 5.03 vs.24.67 ± 2.92,P = 0.011)90 days after surgery were all improved significantly compared to preoperative values.In addition,radiographic followup of five patients showed no restenosis in patients with successful recanalization.With the gradual recovery of hemodynamics,the absolute values of CBF,MTT,and TTP tended to be normal.Conclusions:1)For people in Hunan,endovascular recanalization for NALAO with impaired anterior circulation perfusion is feasible,effective,and relatively safe provided that patients receive rigorous screening.2)This procedure may improve patients’ overall prognosis and quality of life including neurological function,cognitive function and cerebral perfusion.