Application study of angioplasty in intracranial atherosclerotic disease related acute large vessel occlusion——ANGEL-ACT subgroup analysis
Objective To analyze the role of aggressive angioplasty in the treatment of intracranial atherosclerotic disease(ICAD)-related acute large vessel occlusion stroke(LVOS).Methods From the ANGEL-ACT database,475 patients with ICAD-related LVOS were included and divided into two groups based on the treatment approach:the aggressive angioplasty group[defined as angioplasty performed after one mechanical thrombectomy(MT),or angioplasty alone](194 cases)and the passive angioplasty group(defined as MT alone,or angioplasty performed after ≥2 MT attempts)(281 cases).The efficacy and safety between the two groups were compared.The primary efficacy endpoints were immediate post-procedure modified Thrombolysis in Cerebral Infarction(mTICI)grade(≥ 2b indicating successful reperfusion)and modified Rankin Scale(mRS)score at 90 days post procedure.Safety endpoints included symptomatic intracranial hemorrhage within 24 hours post procedure and mortality at 90 days post procedure.Binary logistic regression was used to analyze the odds ratios(OR)for those endpoints between the passive and aggressive angioplasty groups,with P＜0.05 indicating statistical significance.Results Among the 475 patients,the symptomatic intracranial hemorrhage rates within 24 hours post procedure were 3.1％(6/194)in the aggressive angioplasty group and 5.0％(14/281)in the passive angioplasty group(P=0.329).The immediate post procedure mTICI grade ≥2b rates were 96.9％(188/194)in the aggressive angioplasty group and 91.8％(258/281)in the passive angioplasty group(P=0.023).At 90 days post procedure,the rates of mRS 0-1 were 55.7％(108/194)in the aggressive angioplasty group and 38.8％(109/281)in the passive angioplasty group(P＜0.001),with mortality rates of 10.8％(21/194)and 18.9％(53/281)respectively(P=0.018).After adjusting for age,sex,preoperative National Institutes of Health Stroke Scale score,atrial fibrillation,primary hypertension,and tandem lesions,binary logistic regression analysis showed an OR of 1.82(95％CI:1.00-3.31,P=0.051)for 90-day mortality and an OR of 0.55(95％CI:0.37-0.82,P=0.004)for mRS 0-1 in the passive angioplasty group compared with the aggressive angioplasty group.The OR value for achieving mTICI grade 2b-3 was 0.33(95％CI:0.13-0.85,P=0.022).Conclusion Early aggressive angioplasty in patients with ICAD-related acute large vessel occlusion reduces 90-day mortality and improves neurological functional recovery and cerebral reperfusion,demonstrating superior efficacy and safety.
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