Abstract：
UNASSIGNED: Tandem lesions consist of cervical internal carotid artery (ICA) stenosis or occlusion, most commonly of atherosclerosis or dissection etiology, plus a large vessel occlusion. In this study, we compare outcomes in patients with atherosclerosis versus dissection of the cervical ICA.
UNASSIGNED: This multicenter retrospective cohort study includes data from tandem lesion patients who underwent endovascular treatment from 2015 to 2020. Atherosclerosis was defined as ICA stenosis/occlusion associated with a calcified lesion and dissection by the presence of a tapered or flame-shaped lesion and intramural hematoma. Primary outcome: 90-day functional independence (modified Rankin Scale score, 0-2); secondary outcomes: 90-day favorable shift in the modified Rankin Scale score, modified Thrombolysis in Cerebral Infarction score 2b-3, modified Thrombolysis in Cerebral Infarction score 2c-3, symptomatic intracranial hemorrhage, parenchymal hematoma type 2, petechial hemorrhage, distal embolization, early neurological improvement, and mortality. Analysis was performed with matching by inverse probability of treatment weighting.
UNASSIGNED: We included 526 patients (68 [59-76] years; 31% females); 11.2% presented dissection and 88.8%, atherosclerosis. Patients with dissection were younger, had lower rates of hypertension, hyperlipidemia, diabetes, and smoking history. They also exhibited higher rates of ICA occlusion, multiple stents (>1), and lower rates of carotid self-expanding stents. After matching and adjusting for covariates, there were no differences in 90-day functional independence. The rate of successful recanalization was significantly lower in the dissection group (adjusted odds ratio, 0.38 [95% CI, 0.16-0.91]; P=0.031), which also had significantly higher rates of distal emboli (adjusted odds ratio, 2.53 [95% CI, 1.15-5.55]; P=0.021). There were no differences in other outcomes. Acute ICA stenting seemed to increase the effect of atherosclerosis in successful recanalization.
UNASSIGNED: This study reveals that among patients with acute stroke with tandem lesions, cervical ICA dissection is associated with higher rates of distal embolism and lower rates of successful recanalization than atherosclerotic lesions. Using techniques to minimize the risk of distal embolism may mitigate this contrast. Further prospective randomized trials are warranted to fully understand these associations.
UNASSIGNED: This multicenter retrospective cohort study includes data from tandem lesion patients who underwent endovascular treatment from 2015 to 2020. Atherosclerosis was defined as ICA stenosis/occlusion associated with a calcified lesion and dissection by the presence of a tapered or flame-shaped lesion and intramural hematoma. Primary outcome: 90-day functional independence (modified Rankin Scale score, 0-2); secondary outcomes: 90-day favorable shift in the modified Rankin Scale score, modified Thrombolysis in Cerebral Infarction score 2b-3, modified Thrombolysis in Cerebral Infarction score 2c-3, symptomatic intracranial hemorrhage, parenchymal hematoma type 2, petechial hemorrhage, distal embolization, early neurological improvement, and mortality. Analysis was performed with matching by inverse probability of treatment weighting.
UNASSIGNED: We included 526 patients (68 [59-76] years; 31% females); 11.2% presented dissection and 88.8%, atherosclerosis. Patients with dissection were younger, had lower rates of hypertension, hyperlipidemia, diabetes, and smoking history. They also exhibited higher rates of ICA occlusion, multiple stents (>1), and lower rates of carotid self-expanding stents. After matching and adjusting for covariates, there were no differences in 90-day functional independence. The rate of successful recanalization was significantly lower in the dissection group (adjusted odds ratio, 0.38 [95% CI, 0.16-0.91]; P=0.031), which also had significantly higher rates of distal emboli (adjusted odds ratio, 2.53 [95% CI, 1.15-5.55]; P=0.021). There were no differences in other outcomes. Acute ICA stenting seemed to increase the effect of atherosclerosis in successful recanalization.
UNASSIGNED: This study reveals that among patients with acute stroke with tandem lesions, cervical ICA dissection is associated with higher rates of distal embolism and lower rates of successful recanalization than atherosclerotic lesions. Using techniques to minimize the risk of distal embolism may mitigate this contrast. Further prospective randomized trials are warranted to fully understand these associations.
摘要：
■串联病变包括颈内动脉（ICA）狭窄或闭塞，最常见的动脉粥样硬化或夹层病因，加上大血管闭塞。在这项研究中,我们比较了动脉粥样硬化患者与宫颈ICA夹层患者的结局.
■这项多中心回顾性队列研究包括2015年至2020年接受血管内治疗的串联病变患者的数据。动脉粥样硬化被定义为ICA狭窄/闭塞与钙化病变和夹层相关的锥形或火焰状病变和壁内血肿。主要结果：90天功能独立性（改良Rankin量表评分，0-2）；次要结果：改良Rankin量表评分90天有利变化，改良脑梗死溶栓评分2b-3,改良脑梗死溶栓评分2c-3,症状性颅内出血,2型实质性血肿，点状出血，远端栓塞,早期神经改善，和死亡率。通过治疗加权的逆概率进行匹配分析。
■我们纳入了526例患者（68[59-76]岁；31％为女性）；11.2％呈现夹层，88.8％，动脉粥样硬化。夹层患者更年轻，高血压发病率较低，高脂血症,糖尿病,和吸烟史。他们还表现出更高的ICA闭塞率，多支架（>1），颈动脉自膨胀支架的发生率较低。在匹配和调整协变量后，90日功能独立性无差异.夹层组成功再通率显著较低(调整后的比值比，0.38[95%CI，0.16-0.91]；P=0.031)，远端栓塞的发生率也明显较高(调整后的比值比，2.53[95%CI，1.15-5.55]；P=0.021）。其他结果没有差异。急性ICA支架置入似乎会增加动脉粥样硬化在成功再通中的作用。
■这项研究表明，在患有串联病变的急性中风患者中，与动脉粥样硬化病变相比,宫颈ICA夹层与较高的远端栓塞率和较低的成功再通率相关.使用技术来最小化远端栓塞的风险可以减轻这种对比。需要进一步的前瞻性随机试验来充分理解这些关联。
■这项多中心回顾性队列研究包括2015年至2020年接受血管内治疗的串联病变患者的数据。动脉粥样硬化被定义为ICA狭窄/闭塞与钙化病变和夹层相关的锥形或火焰状病变和壁内血肿。主要结果：90天功能独立性（改良Rankin量表评分，0-2）；次要结果：改良Rankin量表评分90天有利变化，改良脑梗死溶栓评分2b-3,改良脑梗死溶栓评分2c-3,症状性颅内出血,2型实质性血肿，点状出血，远端栓塞,早期神经改善，和死亡率。通过治疗加权的逆概率进行匹配分析。
■我们纳入了526例患者（68[59-76]岁；31％为女性）；11.2％呈现夹层，88.8％，动脉粥样硬化。夹层患者更年轻，高血压发病率较低，高脂血症,糖尿病,和吸烟史。他们还表现出更高的ICA闭塞率，多支架（>1），颈动脉自膨胀支架的发生率较低。在匹配和调整协变量后，90日功能独立性无差异.夹层组成功再通率显著较低(调整后的比值比，0.38[95%CI，0.16-0.91]；P=0.031)，远端栓塞的发生率也明显较高(调整后的比值比，2.53[95%CI，1.15-5.55]；P=0.021）。其他结果没有差异。急性ICA支架置入似乎会增加动脉粥样硬化在成功再通中的作用。
■这项研究表明，在患有串联病变的急性中风患者中，与动脉粥样硬化病变相比,宫颈ICA夹层与较高的远端栓塞率和较低的成功再通率相关.使用技术来最小化远端栓塞的风险可以减轻这种对比。需要进一步的前瞻性随机试验来充分理解这些关联。
