Effect of direct angioplasty therapy on acute middle cerebral artery occlusion with good leptomeningeal collateral

Luo, Ying; Huang, Jun; Yang, Yang; Li, Hong; Chen, Xiu; Li, Xiaogang; Li, Zuoxiao; Liu, Bo; Li, Jinglun

doi:10.1016/j.clineuro.2020.105744

Cited by 7 publications

(2 citation statements)

References 23 publications

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“…Certain studies have reported the advantages of direct angioplasty as a primary treatment for ICAS-ELVO, including shortening the procedure time and reducing the number of procedure device attempts, with similar safety to that of MT 13 14 . However, these studies did not define the clot burden of the included patients, thus potentially affecting the persuasiveness of the results.…”

Section: Discussionmentioning

confidence: 99%

“…Though certain studies have demonstrated the feasibility of direct angioplasty for patients with ICAS-ELVO [11][12][13][14] , these studies did not define the clot burden of the included patients. The microcatheter "first-pass effect" is considered a valid predictor of ICAS-ELVO 15 , and it often suggests an occluded vessel with a small clot burden.…”

Section: Introductionmentioning

confidence: 99%

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Balloon Angioplasty as the First-Choice Treatment for Intracranial Atherosclerosis-Related Emergent Large Vessel Occlusion Involving the Microcatheter “First-Pass Effect”

Zhang

huang

liu

2023

Preprint

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Background: It is unknown whether balloon angioplasty can be a first choice treatment for intracranial atherosclerosis related emergent large vessel occlusion (ICASELVO) with small clot burden. The microcatheter first pass effect is a valid predictor of ICAS-ELVO with small clot. Objective: To determine balloon angioplasty efficacy as first choice treatment for ICASELVO involving the microcatheter first pass effect during endovascular treatment (EVT). Methods: This continuous retrospective analysis assessed ICASELVO patients presenting with the microcatheter first pass effect during EVT. Patients were divided into two first choice treatment based groups: preferred balloon angioplasty (PBA) and preferred mechanical thrombectomy (PMT). Efficacy and safety outcomes were compared between groups. Results: Seventy six patients with ICAS-ELVO involving the microcatheter first pass effect during EVT were enrolled. Compared with patients in PMT group, patients in PBA group were associated with (i) a higher rate of first pass recanalization (54.0% vs. 28.9%, p=.010) and complete reperfusion (expanded thrombolysis in cerebral ischemia;2c; 76.0% vs. 53.8%, p=.049), (ii) a shorter puncture to recanalization time (49.5 min vs. 56.0 min, p<.001), (iii) less operation costs (48,499.5 vs. 99,086.0, p<.001),and (iv) more excellent functional outcomes (modified Rankin scale:0-1; 44.0% vs. 19.2%, p=.032) at 90 days. No significant differences in symptomatic intracranial hemorrhage (12.0% vs. 15.4%, p>.999) and mortality (10.0% vs. 7.7%, p>.999) were noted. Logistic regression analysis revealed that first choice treatment was an independent predictor of 90 day excellent functional outcomes (adjusted odds ratio [aOR] =0.10, 95% CI: 0.02~0.66, p=.017). Conclusion: Balloon angioplasty, as the first choice treatment, potentially improves 90 day functional outcomes for ICASELVO patients with microcatheter first-pass effect during EVT.

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Section: Discussionmentioning

confidence: 99%