Background We sought to examine the feasibility, safety and preliminary efficacy of anterior cerebral artery (ACA) occlusions in patients undergoing endovascular treatment. Methods Four hundred five consecutive patients with large-vessel occlusion treated with endovascular treatment were analysed to identify all patients with acute ACA occlusion who underwent endovascular treatment. Results Twenty had ACA occlusion (primary ACA occlusion: 9, rescue ACA occlusion: 11), 395 patients had other occlusions (internal carotid artery and MCA). The median [IQR] mRS score in the third month was significantly higher in the ACA-rescue occlusion group versus the ACA-primary occlusion group. The rate of haematoma in patients with ACA-occlusions was significantly higher compared with the ACA-primary occlusion group. Moreover, the three-month mortality rate was higher in patients with ACA-rescue than the patients with ACA-primary. Conclusions Although endovascular treatment can be considered in patients with primary ACA occlusions, our data suggest that future clinical trials are needed to determine the efficacy of endovascular treatment for ACA occlusions. Unfavourable outcomes in our study were considered to occur in the rescue ACA occlusions.

İnme dünyadaki mortalite ve morbiditenin en sık nedenlerinden biridir. Birçok etiyolojik faktör içermektedir. İnmenin %85 i iskemik kaynaklıdır. Karotis ve vertebral arter stenozu inme için risk faktörleri olup, erken teşhis ve tedavi rekürrens inmeleri önleyebilmektedir. Karotis arter stentlemesi günümüzde birçok merkezde yaygın olarak yapılmasına rağmen vertebral arter stentlemesi nadir yapılmaktadır. Biz bu olgumuzda, karotis ve vertebral arter stentlemesinin aynı seansta yapılmasının etkili ve güvenilir olduğunu göstererek litaratüre katkıda bulunmayı amaçladık. Anahtar Sözcükler: İskemik inme, karotis arter stentleme, vertebral arter stentleme.

Introduction Endovascular treatment (ET) is a beneficial treatment for M1–2 occlusions of the middle cerebral artery. Mortality and disability rates are high if large vessel occlusions are not treated. While these rates are lower in M3 occlusions, important branch blockages can lead to disability. Endovascular treatment of small vessel occlusions is difficult, and there are no studies on the effectiveness of endovascular treatment for M3 occlusions. Accordingly, in this study, our aim was to assess the feasibility, safety, and preliminary efficacy of endovascular therapy for M3 occlusions. Methods This study involved a retrospective analysis of a prospectively collected from two centres for acute ischemic stroke of the anterior system between July 2015 and April 2020. Demographic, radiologic, procedural and outcome variables were collected for patients who underwent endovascular therapy for acute ischemic stroke of the anterior system. Results Complete or near complete reperfusion (mTICI 2b-3) of the M3 occlusion was achieved in 15 cases (38.5%). Complete (mTICI 3) reperfusion was achieved in 24 cases (61.5%). Twenty-six patients were treated for primary M3 occlusion, while 13 patients with M3 occlusion were treated as a rescue strategy after successful treatment of a proximal greater vascular occlusion. Complete or near complete reperfusion (mTICI 2b-3) of primary occlusion was achieved in eight cases (30.8%), and complete (mTICI 3) reperfusion was achieved in 18 cases (69.2%). In addition, complete or near complete reperfusion (mTICI 2b-3) of rescue M3 occlusion was achieved in seven cases (%53.8), while complete (mTICI 3) reperfusion was achieved in six cases (46.2%). Only one patient with primary M3 occlusion had ICH due to extravasation. The patient's neurological examination one month later was normal. Conclusions This retrospective study demonstrates that endovascular treatment of M3 occlusions is safe, effective and reliable.

ÖZETAMAÇ: İskemik inmenin hem primer hem de sekonder korumasında; karotis artere stent (KAS) yerleştirilmesinin etkinliği ve güvenirliği gösterilmiştir. Bizim bu çalışmadaki amacımız, üçüncü basamak nöroloji kliniğince yapılan KAS işlemininin güvenirliğini göstermek ve iki yıllık sonuçlarını klinik ve radyolojik olarak değerlendirmektir. GEREÇ ve YÖNTEM: Temmuz 2015 ile Temmuz 2016 tarihleri arasında hastanemize başvuran, nöroloji kliniğimiz tarafından değerlendirilip, KAS kararı verilen ve stent uygulanan 27 hasta (ortalama yaş 71.6 [58-85]) çalışıldı. Çalışmaya semptomlu olup karotis arterde anjiyografik olarak %50'nin üzerinde darlık olanlarla, semptomsuz olup karotis arterde %70'in üzerinde darlık olan hastalar alındı. BULGULAR: İşlem başarı oranı %96.3 dür (bir hastada işlemden 2 saat sonra stent içinde trombüs gelişti). KAS işlemi uyguladığımız bu hastaların hiçbirisinde ölüm, miyokart enfarktüsü görülmedi. Bu hastaların 6 aylık takiplerinde hiçbir hastada iskemik serebrovasküler olay veya geçici iskemik atak gelişmedi. Kendi kliniğimizce yapılan karotis doppler takiplerinde hiçbir hastada restenoz izlenmedi. SONUÇ: Endovasküler üzerine eğitim almış nöroloji uzmanları tarafından yapılan karotis artere stent yerleştirilmesi işleminin semptomlu veya semptomsuz hastalarda düşük komplikasyon ve yüksek başarı oranları ile güvenli bir şekilde yapılabileceği ve hastaların daha sağlıklı bir şekilde takip edileceği kanaatindeyiz. Anahtar Sözcükler: Karotis arter stentlemesi, iskemik inme, nöroloji kliniği. RETROSPECTIVE EVALUATION OF CAROTID ARTERY STENTING EXPERIENCE OF A THIRD STAGE NEUROLOGY CLINIC ABSTRACTOBJECTIVE: In the protection of both primary and secondary ischemic stroke, the effectiveness and reliability of the placement of carotid artery stent (CAS) has been demonstrated. Our aim in this study is to demonstrate the reliability of the CAM procedure performed in the tertiary care neurology clinic and the clinical and radiological to evaluation the twoyear results. MATERIAL and METHODS: Twenty-seven patients who applied to our hospital between July 2015 and July 2016, were evaluated by our neurology clinic, decided on CAS and stenting were studied (average age 71.6 [58-85]). Patients with symptomatic onset of the carotid artery stenosis over 50% angiographically, asymptomatic and over 70% stenosis in the carotid artery were included. RESULTS: The operation success rate was 96.3% (a thrombus developed in the stent 2 hours after the operation in a single patient). No deaths or myocardial infarction occurred in any of these patients with CAS. No ischemic cerebrovascular event or transient ischemic attack occurred in any of the patients at 6 months follow-up. No restenosis was observed in any of the carotid doppler follow-ups performed in our clinic. CONCLUSION: We believe that carotid artery stent placement performed by neurologists trained in endovascular surgery can be safely performed with low complication and high success rates in symptomatic or asymptomatic patients and that patients will be monitored ...

No abstract