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Endovascular treatment for acute ischaemic stroke due to medium vessel occlusion:data from ANGEL-ACT registry

Stroke & Vascular Neurology 2023年第1期8卷 51-58页

作者： dapeng Sun Raynald Xiaochuan Huo Baixue Jia Xu Tong Anxin Wang Gaoting Ma Ning Ma Feng Gao dapeng mo Zhongrong Miao 无 Department of Interventional Neuroradiology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Department of Neurosurgery Beijing Fengtai You anmen HospitalBeijingChina China National Clinical Research Center for Neurological Diseases Beijing Tiantan HospitalBeijingChina on behalf of the ANGEL-ACT Study Group

Objectives To investigate the safety and efficacy of endovascular treatment(EVT)for acute medium vessel occlusion(MeVO)in the anterior circulation and to explore the independent predictors of the 90-day good outcome for such *** Data from ANGEL-ACT Registry were analysed in our *** outcomes,such as the modified Rankin Scale(mRS)at 90 days,successful recanalisation rate and symptomatic intracranial haemorrhage(SICH)rate,were compared between MeVO and acute large vessel occlusions(LVO).Then,the independent predictors of the good outcome at 90 days in MeVO patients were determined by the logistic regression *** We included 1032 subjects in the analysis,of which,147 were MeVO and 885 were *** at 90 days distribution(3(0-4)vs 3(0-5),common odds ratio(OR)=1.00,95%confidence interval(CI)0.73 to 1.38,p=0.994),SICH rate(4.8%vs 8.9%;OR=0.59,95%CI 0.26 to 1.34,p=0.205)and successful recanalisation rate(89.8%vs 89.7%;OR=1.0095%CI 0.51 to 1.93,p=0.992)were similar between the MeVO and LVO groups after adjusting for the *** identified that baseline neutrophil-to lymphocyte ratio≤4.1(OR=2.13,95%CI 1.14 to 3.99,p=0.019),baseline National Institutes of Health Stroke Scale≤14(OR=1.96,95%CI 1.02 to 3.80,p=0.045)and mechanical thrombectomy passes≤1(OR=2.16,95%CI 1.14 to 4.11,p=0.021)were independent predictors of the 90-day good outcome in MeVO patients undergoing *** Patients with MeVO achieved similar 90-day mRS,SICH rate and successful recanalisation rate after EVT compared with patients with *** independent predictors of 90-day good outcome in MeVO patients undergoing EVT were determined,which should be highly considered in MeVO stroke management.

关键词： acute occlusion treatment

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Incidence and predictors of futile recanalisation after endovascular therapy in acute vertebrobasilar artery occlusion patients:insight from the ANGEL-ACT registry

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Stroke & Vascular Neurology 2024年第3期9卷 289-294,I0248-I0250页

作者： dapeng Sun Xinguang Yang Xiaochuan Huo Raynald- Baixue Jia Xu Tong Anxin Wang Ning Ma Feng Gao dapeng mo Zhongrong Miao Interventional Neuroradiology Department of NeurologyBeijing Tiantan HospitalCaptial Medical UniversityBeijingChina Department of Neurology Sun Yat-Sen Memorial HospitalGuangzhouGuangdongChina Cerebrovascular Disease Department Neurological Disease CenterBeijing Anzhen HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases Beijing Tiantan HospitalCapital Medical UniversityBeijingChina

Objectives To identify the occurrence rate and predictors of futile recanalisation after endovascular therapy(EVT)for acute vertebrobasilar artery occlusion(VBAO).Methods Participants of the Endovascular Treatment Key Technique and Emergency Workflow Improvement of Acute Ischaemic Stroke(ANGEL-ACT)registry were selected for the *** recanalisation was defined as patients did not achieve a 90-day good outcome(modified Rankin Scale≤3)despite successful recanalisation(modified Treatment in Cerebral Ischaemia Scale≥2b)after the *** logistic regression analysis was conducted to find independent predictors of futile recanalisation in VBAO patients undergoing *** Three hundred and fifteen patients with VBAO who achieved successful recanalisation after EVT were included in current analysis,of whom,155(49.2%)suffered futile recanalisation,and 160 achieved effective *** the multivariable analysis,we found admission National Institutes of Health Stroke Scale(NIHSS)≥19(OR 4.81,95%CI 2.76 to 8.39,p<0.001),platelet-lymphocyte ratio(PLR)≥162.2(OR 1.93,95%CI 1.14 to 3.27,p=0.001),onset-to-puncture time(OTP)≥334min(OR 2.15,95%CI 1.25 to 3.68,p=0.005)and use of general anesthesia(GA)(OR 1.87,95%CI 1.09 to 3.22,p=0.024)were associated with futile *** Futile recanalisation after EVT occurred 49.2%of VBAO patients in the ANGEL-ACT ***≥19,PLR≥162.2,OTP≥334min and use of GA were independent predictors of futile recanalisation.

关键词： patients anesthesia occlusion

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Mechanical thrombectomy with combined stent retriever and contact aspiration versus stent retriever alone for acute large vessel occlusion:data from ANGEL-ACT registry

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Stroke & Vascular Neurology 2023年第4期8卷 318-326页

作者： Xiaochuan Huo dapeng Sun Mingkai Hu Raynald Baixue Jia Xu Tong Gaoting Ma Anxin Wang Ning Ma Feng Gao dapeng mo Zhongrong Miao the ANGEL-ACT Study group Department of Interventional Neuroradiology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases Beijing Tiantan HospitalCapital Medical UniversityBeijingChina

Background and purpose An analysis of the ASTER 2 trial revealed similar final recanalisation levels and clinical outcomes in acute large vessel occlusion(LVO)stroke between stent retrieval(SR)alone as a first-line mechanical thrombectomy(MT)technique(SR alone first-line)and concomitant use of contact aspiration(CA)plus SR as a first-line MT technique(SR+CA first-line).The purpose of the present study was to compare the safety and efficacy of SR+CA first-line with those of SR alone first-line for patients with LVO in *** We conducted the present study by using the data from the ANGEL-ACT *** divided the selected patients into SR+CA first-line and SR alone first-line *** performed logistic regression and generalised linear models with adjustments to compare the angiographic and clinical outcomes,including successful/complete recanalisation after the first technique alone and all procedures,first-pass successful/complete recanalisation,number of passes,90-day modified Rankin Scale,procedure duration,rescue treatment and intracranial haemorrhage within 24 *** Of the 1233 enrolled patients,1069(86.7%)received SR alone first-line,and 164(13.3%)received SR+CA ***+CA first-line was associated with more thrombectomy passes(3(2-4)vs 2(1-2);β=1.77,95%CI=1.55 to 1.99,p0.05)between the two *** Patients undergoing SR+CA first-line had more thrombectomy passes and longer procedure duration than patients undergoing SR alone ***,we suggested that SR+CA first-line was not superior to SR alone first-line in final recanalisation level,first-pass recanalisation level and 90-day clinical outcomes in the Chinese population.

关键词： throm alone occlusion

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Balloon Angioplasty for Symptomatic Intracranial Artery Stenosis (BASIS): protocol of a prospective, multicentre, randomised, controlled trial

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Stroke & Vascular Neurology 2024年第1期9卷 66-74页

作者： Xuan Sun Ming Yang dapeng Sun Guangge Peng Yiming Deng Xingquan Zhao Liping Liu Ning Ma Feng Gao dapeng mo Wengui Yu Yongjun Wang Yilong Wang Zhongrong Miao Department of Interventional Neuroradiology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Department of Neurology Beijing Luhe HospitalCapital Medical UniversityBeijingChina Department of Neurology Comprehensive Stroke&Cerebrovascular CenterUniversity of California IrvineIrvineCaliforniaUSA Chinese Institute for Brain Research BeijingChina National Center for Neurological Diseases BeijingChina Advanced Innovation Center for Human Brain Protection Capital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina Beijing Laboratory of Oral Health Capital Medical UniversityBeijingChina

Background The superiority of balloon angioplasty plus aggressive medical management(AMM)to AMM alone for symptomatic intracranial artery stenosis(sICAS)on efficacy and safety profiles still lacks evidence from randomised controlled trials(RCTs).Aim To demonstrate the design of an RCT on balloon angioplasty plus AMM for *** Balloon Angioplasty for Symptomatic Intracranial Artery Stenosis(BASIS)trial is a multicentre,prospective,randomised,open-label,blinded end-point trial to investigate whether balloon angioplasty plus AMM could improve clinical outcome compared with AMM alone in patients with *** eligible in BASIS were 35–80 years old,with a recent transient ischaemic attack within the past 90 days or ischaemic stroke between 14 days and 90 days prior to enrolment due to severe atherosclerotic stenosis(70%–99%)of a major intracranial *** eligible patients were randomly assigned to receive balloon angioplasty plus AMM or AMM alone at a 1:1 *** groups will receive identical AMM,including standard dual antiplatelet therapy for 90 days followed by long-term single antiplatelet therapy,intensive risk factor management and life-style *** participants will be followed up for *** outcomes Stroke or death in the next 30 days after enrolment or after balloon angioplasty procedure of the qualifying lesion during follow-up,or any ischaemic stroke or revascularisation from the qualifying artery after 30 days but before 12 months of enrolment,is the primary *** BASIS trail is the first RCT to compare the efficacy and safety of balloon angioplasty plus AMM to AMM alone in sICAS patients,which may provide an alternative perspective for treating *** registration number NCT03703635;https://***.

关键词： balloon prospective centre

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Staged carotid artery angioplasty and stenting for patients with high-grade carotid stenosis with high risk of developing hyperperfusion injury:a retrospective analysis of 44 cases

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Stroke & Vascular Neurology 2016年第4期1卷 147-153页

作者： dapeng mo Gang Luo Bo Wang Ning Ma Feng Gao Xuan Sun Xiaotong Xu Zhongrong Miao Department of Interventional Neuroradiology Beijing Tiantan HospitalCapital Medical UniversityChina National Clinical Research Center for Neurological DiseasesCenter of StrokeBeijing Institute for Brain DisordersBeijingChina

Background:Hyperperfusion syndrome(HPS)is a rare but potentially a life-threatening complication after carotid artery angioplasty and stenting(CAS).Staged CAS has been an alternative to prevent *** and methods:44 of 908 patients with high-grade internal carotid artery stenosis or near occlusion were at risk of HPS because of poor collateral flow and impaired cerebral blood flow(CBF).They were treated with first(stage 1),followed by a full CAS(stage 2)1 month *** 30-day outcomes were tabulated and ***:During follow-up,1 of the 44(2.2%)patients developed HPS immediately,3(7%)had postprocedural HPS(ie,transcranial Doppler(TCD)>120%)without clinical symptoms and 3(7%)required stenting at stage 1 for carotid *** stage 1,there were significant improvement between the preprocedural and postprocedural CBF(0.98±0.06 vs 0.85±0.05,p<0.05),mean transit time(MTT;1.05±0.05 vs 1.15±0.05,p<0.05),time to peak(TTP;1.04±0.06 vs 1.20±0.06,p<0.05)on CT perfusion(CTP),and CBF(66.41±7.41 vs 44.44±6.43,p<0.05)on *** stage 2,improvement was seen in CBF(1.01±0.07 vs 0.98±0.06,p<0.05),MTT(1.01±0.05 vs 1.05±0.05,p<0.05),TTP(0.99±0.06 vs 1.04±0.06,p<0.05)on CTP and CBF(66.41±7.41 vs 93.78±18.81,p<0.05)on TCD.2 had postoperative increase of middle cerebral artery mean flow velocity of 120%after stage 2 without clinical ***:Staged carotid artery stenting probably decreased the chance of developing HPS in this group of selected *** requiring a 2-step intervention,staged CAS may be a safe and effective alternative.

关键词： patients carotid perfusion

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Safety and efficacy of oral antiplatelet for patients who had acute ischaemic stroke undergoing endovascular therapy

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Stroke & Vascular Neurology 2021年第2期6卷 230-237页

作者： Xiaochuan Huo Raynald Jing Jing Anxin Wang dapeng mo Feng Gao Ning Ma Yilong Wang Yongjun Wang Zhongrong Miao Neurointervention center Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina Center of Stroke Beijing Institute for Brain DisordersBeijingChina Beijing Tiantan Hospital BeijingChina Neurointervention center Beijing Tiantan HospitalBeijingChina

Background and purpose To investigate the safety and efficacy of oral antiplatelet therapy(APT)for patients who had acute ischaemic stroke(AIS),receiving endovascular therapy(EVT).Methods Patients were divided into non-APT group and APT(single APT or dual APT(DAPT)*** safety and efficacy endpoints at 3-month follow-up were symptomatic intracranial haemorrhage(sICH),recanalisation rate,clinical outcome and *** Among 915 patients who had AIS,those in APT group(n=199)showed shorter puncture-to recanalisation time,lower frequency of intravenous thrombolysis and more use of tirofiban compared with those in non-antiplatelet group(n=716)(pmortality at 3-month follow-up(DAPT(4.8%)versus non-DAPT(17.7%),adjusted OR=0.008,95%CI 0.000 to 0.441,p=0.019).There was no significant difference in sICH between the two *** Oral APT prior to undergoing EVT is safe and may accompany with superior clinical *** may associate with superior clinical outcomes and lower risk of mortality.

关键词： mortality patients acute

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Endovascular revascularisation of acute tandem vertebrobasilar artery occlusion:seven case series with literature reviews

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Stroke & Vascular Neurology 2018年第1期3卷 17-21页

作者： Haihua Yang Ning Ma Shiyong Zhang Xiaochuan Huo Feng Gao Xuan Sun dapeng mo Zhongrong Miao Department of Interventional Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Department of Neurology Beijing Daxing HospitalCapital Medical UniversityBeijingChina Department of Interventional Neurology Beijing Fengtai Youanmen HospitalBeijingChina

background The outcome of acute ischaemic stroke due to tandem vertebrobasilar artery occlusion was *** revascularisation may be a positive approach for acute basilar artery occlusion combined with vertebral ostium stenosis or *** reported seven patients with acute vertebrobasilar tandem occlusion by using angioplasty or stenting for proximal lesion and thrombectomy for distal *** and methods Consecutive patients with acute tandem vertebrobasilar artery occlusion at two centres were included in this *** retrospectively analysed the clinical,technical and functional outcomes of the *** From March 2016 to March 2017,seven patients were *** mean age and National Institute of Health Stroke Scale score at admission was 57 years and 22,respectively.A reverse approach was used in five *** Thrombolysis in Cerebral Infarction score 2b-3 was acquired in all *** were no procedural *** modified Rankin Scale score was 1-2 for three patients and 4 for one patient at 3 *** patients died at 3 months of *** Endovascular revascularisation may be feasible for acute tandem vertebrobasilar artery occlusion,and more researches are needed.

关键词： occlusion acute vertebrobasilar

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Acute Ischaemic Stroke Cooperation Group of Endovascular Treatment (ANGEL) registry: study protocol for a prospective, multicentre registry in China

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Stroke & Vascular Neurology 2019年第1期4卷 57-60页

作者： Xiaochuan Huo Ning Ma dapeng mo Feng Gao Ming Yang Yilong Wang Yongjun Wang Zhongrong Miao ANGEL investigators Neurointervention Center Beijing Tiantan HospitalBeijingChina Department of Interventional Neurology Beijing Tiantan HospitalBeijingChina Neurology Beijing Tiantan HospitalBeijingChina

Background and purpose Endovascular treatment could improve functional outcomes and reduce mortality in patients with intracranial large artery occlusion. This registry aims to evaluate the endovascular treatment delivery and to improve endovascular treatment algorithm in clinical practice for patients with stroke in China. Methods and analysis This multicentric, nationwide, prospective registry plans to include 20 stroke centres and recruit 900 consecutive AIS patients with large- artery occlusion under endovascular treatment. This registry will enrol acute large vessel occlusion patients suitable for endovascular treatment and the inclusion and exclusion criteria. In this study, 90 days functional independence (modified Rankin Scale score ≤2) is the primary efficacy endpoint. The procedural efficacy endpoint of this registry is target artery recanalisation defined by modified Thrombolysis in Cerebral Infarction score 2b or 3 after endovascular therapy. Symptomatic intracranial haemorrhage with 24±3 hours after the procedure is the primary safety endpoint of this registry. Ethics and dissemination Beijing Tiantan Hospital’s Ethics committee and all other participating centres approved the protocol and data collection of Acute Ischaemic Stroke Cooperation Group of Endovascular Treatment registry. Each participant or representative had a written informed consent.

关键词： prospective centre registry

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A comparison between acute large vessel occlusion in the posterior circulation and anterior circulation after endovascular treatment:the ANGEL-ACT registry experience

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Stroke & Vascular Neurology 2022年第4期7卷 285-293,I0001-I0004页

作者： Xuan Sun Jingyu Zhang Xu Tong Baixue Jia dapeng mo Ning Ma Feng Gao Lian Liu Xiaochuan Huo Ligang Song Yiming Deng Zhongrong Miao Interventional Neuroradiology Center Beijing Tiantan HospitalCapital Medical UniversityBeijingChina

Background and purpose Endovascular treatment(EVT)has shown an overwhelming benefit for acute anterior circulation artery occlusion(ACO).Whether it can achieve the same outcomes in posterior circulation artery occlusion(PCO)has not been well *** aimed to evaluate the characteristics and prognosis of ACO and PCO after EVT in a nationwide *** The present analysis was based on the prospective ANGEL-ACT Registry in China between November 2017 and March *** data,periprocedural times,recanalisation rate,intracranial haemorrhage(ICH)and 90-day functional outcomes were compared between the ACO and PCO *** A total of 1793 patients were analysed including 397(22.1%)consecutive patients with PCO and 1396(77.9%)patients with ACO treated with EVT.A larger proportion of patients with PCO had intracranial atherosclerotic disease and received extra angioplasty during *** recanalisation and 90-day favourable functional outcomes did not differ significantly between the two *** with PCO showed lower 24-hour ICH and symptomatic ICH *** was a trend towards higher mortality rate in the PCO group(22.09%vs 14.44%;adjusted OR 1.286(95%CI 0.820 to 2.017),p=0.2731),especially when the onset to puncture time was over 6 hours(30.77%vs 11.13%;adjusted OR 2.673(95%CI 1.280 to 5.583),p=0.0089,interactive p=0.0002).Conclusions In this large prospective multicentre registry,there was a significant difference in the characteristics and periprocedural features between patients with PCO and ***,successful recanalisation and 90-day favourable functional outcomes in PCO were equivalent to those in ACO.

关键词： occlusion acute treatment

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Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of cerebral venous sinus thrombosis

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Stroke & Vascular Neurology 2020年第2期5卷 152-158页

作者： Yuhua Fan Jian Yu Hongbing Chen Jian Zhang Jiangang Duan dapeng mo Wenhao Zhu Bo Wang Fubing Ouyang Yicong Chen Linfang Lan Jinsheng Zeng Chinese Stroke Association Stroke Council CVST Guideline Writing Committee Department of Neurology The First Affiliated HospitalSun Yat-sen UniversityGuangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological DiseasesNational Key Clinical Department and Key Discipline of NeurologyGuangzhouChina Department of Neurology and Department of Emergency Xuanwu HospitalCapital Medical UniversityBeijingChina Department of Interventional Neuroradiology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Department of Neurology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina 不详

Aim Cerebral venous sinus thrombosis(CVST)is a less common cerebrovascular disease that predominantly affects young *** incidence of CVST is 2-5/10000000/year,accounting for 0.5%-1%of all *** reduce mortality and morbidity associated with CVST,Chinese Stroke Association commissioned the authors to write the current guideline on the management of *** PubMed(MEDLINE),CNKI and Wanfang database were searched for studies related to CVST from 1 January 1990 to 31 July *** were synthesised by evidence *** recommendation was fully discussed by the writing group members and reviewed by Chinese Stroke Association Stroke Fellow *** of evidence grading algorithm of Chinese Stroke Association was used to grade each *** This guideline mainly focuses on the diagnostic evaluation,therapeutic strategies and secondary prevention of ***/CTV and MRI/MRV are recommended in the initial imaging evaluation of patients with suspected *** therapy with low-molecular weight heparin should be initiated in patients with CVST *** the acute stage,warfarin is recommended for 3-6 months to prevent the recurrence of CVST and other venous thromboembolic *** The guideline summarises the current evidence regarding the management of CVST,and provides references for diagnosis,treatment and secondary prevention of CVST in China.

关键词： prevention tables initiated

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