整体交换技术与传统交换技术治疗症状性颅内动脉粥样硬化性狭窄的有效性及安全性对比研究OA

Objective To compare the differences in efficacy and safety between the over-the-wire(OTW)technique and the conventional exchange technique for the treatment of symptomatic intracranial atherosclerotic stenosis(ICAS).Methods Consecutive patients with ICAS who underwent endovascular interventional therapy at the Department of Neurosurgery of the First Affiliated Hospital of Harbin Medical University between January 1,2024,and June 30,2025,were retrospectively enrolled.Clinical data were collected for all patients,including age,sex,cerebrovascular risk factors(hypertension,diabetes mellitus,coronary heart disease,hyperlipidemia,smoking history,and history of alcohol consumption),clinical presentation at admission(ischemic stroke,transient ischemic attack[TIA]),modified Rankin scale(mRS)score at admission,National Institutes of Health stroke scale(NIHSS)score at admission,time from last symptom onset to surgical intervention,mRS score at discharge,NIHSS score at discharge.Imaging data included the presence of vascular tortuosity,lesion location(C4-C7 segments of the internal carotid artery,M1 segment of the middle cerebral artery,V4 segment of the vertebral artery,basilar artery),normal vessel diameter distal to the lesion,vessel diameter at the stenosis site,degree of stenosis,and lesion length.At 6 months postoperatively,neurological function was assessed via outpatient clinic visit or telephone interview using the mRS,with mRS score≤2 was defined as a favorable outcome,whereas a score≥3 was defined as an unfavorable outcome.Postoperative follow-up for in-stent restenosis was performed using CT angiography(CTA)or DSA,with in-stent restenosis defined as stenosis≥50％of the luminal diameter of the target vessel.The primary safety endpoint was the incidence of perioperative complications(intracerebral hematoma,subarachnoid hemorrhage,possible plaque dislodgement or perforator vessel injury,large vessel occlusion,and cardiorespiratory arrest).The primary efficacy endpoints were the immediate post-procedure residual stenosis rate and the 6-month in-stent restenosis rate.The secondary endpoints included the 6-month mRS score,operative duration(time elapsed from guidewire/catheter arrival at the stenosis site to successful stent deployment),and hospitalization cost(total expenses incurred from admission to discharge).Propensity score matching(PSM)was utilized to match patients in the OTW technique group with those in the conventional exchange technique group.A 1:2 nearest-neighbor matching without replacement using a caliper width set to 0.2 was performed.Balance of the control variables was assessed before and after matching to evaluate the efficacy and safety of both groups.Results A total of 224 patients with ICAS who underwent endovascular treatment were included,comprising 152 males and 72 females,with an age range of 53-67 years and a median age of 61(53,67)years.Among them,149 patients were in the conventional exchange technique group and 75 in the OTW technique group.All patients underwent standalone intracranial artery stenting;no bail-out balloon angioplasty procedures were performed,and stent deployment was successful in all cases.Following PSM,a total of 156 patients with ICAS who received endovascular treatment were matched,consisting of 92patients in the conventional exchange technique group and64patients in the OTW technique group.(1)Prior to PSM,compared with the conventional exchange technique group,the OTW technique group exhibited a higher proportion of patients with diabetes mellitus and a history of alcohol consumption,as well as shorter lesion lengths(all P<0.05).Statistically significant differences were observed between the two groups regarding the distribution of lesion location,admission mRS score,discharge mRS score,and discharge NIHSS score(all P<0.05).No statistically significant differences was found in the remaining clinical baseline characteristics(all P>0.05).After PSM,no statistically significant differences was observed between the two groups across all clinical data comparisons(all P>0.05).(2)No large vessel occlusion occurred during the perioperative period in either group.Both before and after PSM,there were no statistically significant differences between the two groups concerning the incidence of perioperative complications,immediate residual stenosis rate,6-month in-stent restenosis rate,or the proportion of patients achieving a favorable functional outcome(mRS score≤2)at 6 months postoperatively(all P>0.05).However,compared with the conventional exchange technique group,the OTW technique group demonstrated significantly shorter operative durations and lower hospitalization costs both before and after PSM(before PSM:12[11,17]min vs.21[17,26]min;92 852.91[89 709.87,95 737.10]RMB vs.97 604.28[93 952.07,101 929.94]RMB;after PSM:13[11,18]min vs.21[18,27]min;92 980.18[89 771.57,95 943.07]RMB vs.99 026.94[94 673.07,103 244.83]RMB;all P<0.01).Conclusion Compared to the conventional exchange technique,the OTW technique significantly reduces procedure time and hospitalization cost,while demonstrating comparable safety and efficacy outcomes perioperative and during the 6-month follow-up period.