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

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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

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

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

Endovascular therapy in acute anterior circulation large vessel occlusive patients with a large infarct core(ANGEL-ASPECT):protocol of a multicentre randomised trial

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Stroke & Vascular Neurology 2023年第2期8卷 169-174页

作者： xiaochuan huo Gaoting Ma Xuelei Zhang Yuesong Pan Xu Tong Dapeng Sun Liping Liu Yilong Wang David S Liebeskind Yongjun Wang Vitor Mendes Pereira Zeguang Ren Zhongrong Miao Department of Interventional Neuroradiology Beijing Tiantan HospitalBeijingChina Department of Neurology Beijing Tiantan HospitalBeijingChina Clinical Research Center Capital Medical UniversityInstitute of Brain DisordersBeijingChina China National Clinical Research Center for Neurological Diseases Beijing Tiantan HospitalBeijingChina Department of Neurology University of CaliforniaLos AngelesCaliforniaUSA Division of Neurosurgery Department of SurgerySt Michael's HospitalUniversity of TorontoTorontoOntarioCanada Department of Neurosurgery The Affiliated Hospital of Guizhou Medical UniversityGuiyangGuizhouChina

Background The benefit of stroke thrombectomy for large infarct core still lacks robust randomised controlled *** To demonstrate the design of a clinical trial on endovascular therapy for acute anterior circulation large vessel occlusion(LVO)patients with large infarct core *** ANGEL-ASPECT is a multicentre,prospective,randomised,open-label,blinded End-point trial to evaluate whether best medical management(BMM)combined with endovascular therapy improves neurological functional outcomes as compared with BMM alone in acute LVO patients with Alberta Stroke Program Early CT Score(ASPECTS)of 3-5 on non-contrast CT or infarct core volume range of 70-100 mL(defined as rCBF<30%on CT perfusion or ADC<620 on MRI)up to 24 hours from symptom onset or last seen *** outcomes The primary efficacy outcome is 90(±7)days modified Rankin *** intracranial haemorrhage within 48 hours from randomisation is the primary safety *** The ANGEL-ASPECT trial will screen patients with large infarct core(ASPECTS 3-5 or 70-100 mL)through image evaluation criteria within 24 hours and explore the efficacy and safety of endovascular therapy compared with BMM.

关键词： patients infarct acute

急性基底动脉闭塞血管内治疗成功再通后90天不良临床结局的发生率和相关影响因素

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中华医学杂志 2023年第29期103卷 2233-2238页

作者：孙大鹏霍晓川缪中荣首都医科大学附属北京天坛医院介入神经病学科北京100070

目的探索急性基底动脉闭塞血管内治疗成功再通后90 d的不良临床结局的发生率和相关因素。方法本研究的研究人群来自一项于2015年6月至2017年12月的多中心、前瞻性、登记研究:血管内治疗急性缺血性脑卒中协作组(ANGEL)登记研究。收集患... 详细信息

目的探索急性基底动脉闭塞血管内治疗成功再通后90 d的不良临床结局的发生率和相关因素。方法本研究的研究人群来自一项于2015年6月至2017年12月的多中心、前瞻性、登记研究:血管内治疗急性缺血性脑卒中协作组(ANGEL)登记研究。收集患者的人口统计学特征,既往史,个人史,生命体征,美国国立卫生研究院卒中量表(NIHSS)评分,影像学检查,发病/入院/穿刺/手术结束时间点,手术相关变量,术中用药情况,术毕闭塞血管开通情况,病因分型,90 d改良Rankin量表(mRS)评分。血管内治疗术毕成功再通的定义为改良脑梗死溶栓(mTICI)分级2b~3级,不良临床结局定义为患者90 d mRS评分4~6分。多因素logistic回归模型分析来确定不良临床结局的相关因素。结果170例接受血管内治疗且成功再通的急性基底动脉闭塞患者纳入本研究,男性128例,女性42例,年龄[M(Q_(1),Q_(3))]64(55,70)岁。其中72例患者(42.4%)发生了不良临床结局,98例患者(57.6%)发生了良好临床结局。多因素logistic回归模型分析结果显示,高基线NIHSS评分(OR=1.166,95%CI:1.109~1.225,P<0.001)和高术前收缩压(OR=1.032,95%CI:1.010~1.053,P=0.003)是不良临床结局的相关影响因素。结论急性基底动脉血管内治疗成功再通后90 d不良临床结局的发生率为42.4%,高基线NIHSS评分和高术前收缩压与不良临床结局相关。

关键词：卒中血管内治疗急性基底动脉闭塞成功再通不良临床结局随访研究

Performance of automated CT ASPECTS in comparison to physicians at different levels on evaluating acute ischemic stroke at a single institution in China

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Chinese Neurosurgical Journal 2021年第4期7卷 249-257页

作者： xiaochuan huo Raynald Hailan Jin Yin Yin Guangming Yang Zhongrong Miao Department of Interventional Neuroradiology Beijing Tiantan HospitalCapital Medical UniversityBeijing 100070China Department of R&D UnionStrong(Beijing)Technology Co.LtdBeijingChina

Background:Our aim was to evaluate the sensitivity and specificity of the automated computer-based Alberta Stroke Program Early CT Score(e-ASPECTS)for acute stroke patients and compare the result with physicians at different ***:In our center,e-ASPECTS and 9 physicians at different levels retrospectively and blindly assessed baseline computed tomography(CT)images of 55 ***,specificity,receiver-operating characteristic curves,Bland–Altman plots with mean score error,and Matthews correlation coefficients were *** were made between the scores by physicians and e-ASPECTS with diffusion-weighted imaging(DWI)being the ground *** methods for clustered data were used to estimate sensitivity and specificity in the region-based ***:In total,1100(55 patients×20 regions per patient)ASPECTS regions were *** the region-based analysis,sensitivity of e-ASPECTS was better than junior doctors and residents(0.576 vs 0.165 and 0.111,p<0.05)but inferior to senior doctors(0.576 vs 0.617).Specificity was lower than junior doctors and residents(0.883 vs 0.971 and 0.914)but higher than senior doctors(0.883 vs 0.809,p<0.05).E-ASPECTS had the best Matthews correlation coefficient of 0.529,compared to senior doctors,junior doctors,and residents(0.463,0.251,and 0.087,respectively).Conclusions:e-ASPECTS showed a similar performance to that of senior physicians in the assessment of brain CT of acute ischemic stroke patients with the Alberta Stroke Program Early CT score method.

关键词： ASPECTS Computed tomography Ischemic stroke Physicians Automatic device

Chinese Stroke Association guidelines for clinical management of ischaemic cerebrovascular diseases:executive summary and 2023 update

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Stroke & Vascular Neurology 2023年第6期8卷 I0087-I0133页

作者： Liping Liu Zixiao Li Hongyu Zhou Wanying Duan xiaochuan huo Weihai Xu Shujuan Li Ximing Nie Huihui Liu Jinjie Liu Dapeng Sun Yufei Wei Guitao Zhang Weizhuang Yuan Lina Zheng Jingyi Liu David Wang Zhongrong Miao Yongjun Wang Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina National Center for Healthcare Quality Management in Neurological Diseases BeijingChina Research Unit of Artificial Intelligence in Cerebrovascular Disease Chinese Academy of Medical SciencesBeijingChina Chinese Institute for Brain Research BeijingChina Neurological Disease Center Cerebral Vascular Disease DepartmentBeijing Anzhen HospitalCapital Medical UniversityBeijingChina Department of Neurology State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Department of Neurology National Clinical Research Center for Cardiovascular DiseasesFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Department of Neurology and Suzhou Clinical Research Center of Neurological Disease the Second Affiliated Hospital of Soochow UniversitySuzhouChina Department of General Medicine Dalian Municipal Central Hospital Affiliated Dalian University of TechnologyDalianChina Interventional Neuroradiology Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina Neurovascular Division Department of NeurologyBarrow Neurological InstituteSt.Joseph's Hospital and Medical CenterPhoenixArizonaUSA Advanced Innovation Center for Human Brain Protection Capital Medical UniversityBeijingChina

Background China is one of the countries with the highest burden of *** multidimensional management guidelines will help clinicians practise evidence-based care,improve patient outcomes and alleviate societal *** update of the 2019 edition will provide the latest comprehensive recommendations for the diagnosis and treatment of ischaemic cerebrovascular *** We conducted a comprehensive search on MEDLINE(via PubMed)up to 31 August *** writing team established the recommendations through multiple rounds of online and offline *** recommendation was graded using the evidence grading algorithm developed by the Chinese Stroke Association(CSA).The draft was reviewed and finalised by the CSA Stroke Guidelines Writing *** This update included revisions of 15 existing recommendations and 136 new recommendations in the following areas of stroke care:emergency assessment and diagnosis of ischaemic cerebrovascular disease,acute-phase reperfusion therapy,evaluation of underlying mechanisms,antithrombotic therapy,prevention and treatment of complications,and risk factor *** This guideline updated the recommendations for the clinical management of ischaemic cerebrovascular disease from 2019.

关键词： diagnosis prevention discussions

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)(p<0.05 for all).Oral APT was found to be associated with superior clinical outcome compared with non-APT(APT(44.2%)versus non-APT(41.1%)),adjusted OR=2.605,95% CI 1.244 to 5.455,p=0.011).DAPT showed superior clinical outcome compared with non-APT(DAPT(56.5%)versus non-APT(41.1%),adjusted OR=5.405,95% CI 1.614 to 18.102,p=0.006)and lower risk of mortality 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

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