Safety of endovascular therapy for symptomatic intracranial artery stenosis: a national prospective registry

Stroke and Vascular Neurology

article

Yabing Wang¹  Tao Wang¹  Adam Andrew Dmytriw²  Kun Yang³  Liqun Jiao¹  Huaizhang Shi⁴  Jie Lu⁵  Tianxiao Li⁶  Yujie Huang⁷  Zhenwei Zhao⁸  Wei Wu⁹  Jieqing Wan^1,10  Qinjian Sun^1,11  Bo Hong^1,12  Yongli Li^1,13  Liyong Zhang^1,14  Jianfeng Chu^1,15  Qiong Cheng^1,16  Yiling Cai^1,17  Pengfei Wang^1,18  Qi Luo^1,19  Hua Yang^2,20  Baijing Dong^2,21  Yang Zhang^2,22  Jun Zhao^2,23  Zuoquan Chen^2,24  Wei Li^2,25  Xiaoxin Bai^2,26  Weiwen He^2,27  Xueli Cai^2,28  Maimai Ti^2,29  Osama O Zaidat^3,30 

[1] Department of Neurosurgery , Xuanwu Hospital;Neuroendovascular Program , Massachusetts General Hospital;Department of Evidence-Based Medicine , Xuanwu Hospital;Department of Neurosurgery , First Affiliated Hospital of Harbin Medical University;Department of Radiology , Xuanwu Hospital;Center of Neurointerventional Therapy , Henan Provincial People's Hospital;Department of Neurology , Nanjing Drum Tower Hospital;Department of Neurosurgery , Tangdu Hospital Fourth Military Medical University;Department of Neurology , Shandong University Qilu Hospital;Department of Neurosurgery , Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital;Department of Neurology , Shandong Provincial Hospital;Neusurgery , Changhai Hospital;Department of Neurosurgery , Second Affiliated Hospital of Harbin Medical University;Department of Neurosurgery , Liaocheng People's Hospital;Department of Neurosurgery , Jining First People's Hospital;Department of Neurology , Fujian Provincial Hospital;Department of Neurology , 306 Hospital of People's Liberation Army;Department of Neurosurgery , Tianjin Huanhu Hospital;Department of Neurosurgery , Jilin University First Hospital;Department of Neurology , Affiliated Hospital of Guiyang Medical College;Department of Neurosurgery , Fourth Affiliated Hospital of Harbin Medical University;Department of Neurosurgery , Peking University First Hospital;Department of Neurology , Liaocheng Second People's Hospital;Department of Neurology , Shanghai Tenth People's Hospital;Department of Neurosurgery , Tianjin Medical University General Hospital;Department of Neurosurgery , The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine;Department of Neurosurgery , Guangzhou Medical University Second Affiliated Hospital;Department of Neurology , Lishui Hospital, Zhejiang University School of Medicine;Department of Neurosurgery , Xinjiang Medical University Affiliated First Hospital;Neurology Program , North East Ohio Medical School, Mercy St Vincent Mercy Medical Center

关键词: angioplasty and stenting;    atherosclerosis;    intracranial stenosis;    outcome;    prospective registry;   

DOI  :  10.1136/svn-2021-000979

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Introduction The safety outcomes of endovascular therapy for intracranial artery stenosis in a real-world stetting are largely unknown. The Clinical Registration Trial of Intracranial Stenting for Patients with Symptomatic Intracranial Artery Stenosis (CRTICAS) was a prospective, multicentre, real-world registry designed to assess these outcomes and the impact of centre experience.Methods 1140 severe, symptomatic intracranial arterial stenosis (ICAS) patients treated with endovascular therapy were included from 26 centres, further divided into three groups according to the annual centre volume of intracranial angioplasty and stent placement procedures over 2 years: (1) high volume for ≥25 cases/year; (2) moderate volume for 10–25 cases/year and (3) low volume for <10 cases/year.Results The rate of 30-day stroke, transient ischaemic attack or death was 9.7% (111), with 5.4%, 21.1% and 9.7% in high-volume, moderate-volume and low-volume centres, respectively (p<0.05). Multivariable logistic regression confirmed high-volume centres had a significantly lower primary endpoint compared with moderate-volume centres (OR=0.187, 95% CI: 0.056 to 0.627; p≤0.0001), while moderate-volume and low-volume centres showed no significant difference (p=0.8456).Conclusion Compared with the preceding randomised controlled trials, this real-world, prospective, multicentre registry shows a lower complication rate of endovascular treatment for symptomatic ICAS. Non-uniform utilisation in endovascular technology, institutional experience and patient selection in different volumes of centres may have an impact on overall safety of this treatment.

【 授权许可】

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