Table 3_In situ post-ischemic conditioning by temporary balloon occlusion for acute ischemic stroke: a modified reperfusion technique and adverse event monitoring.docx

BackgroundWith the development of endovascular therapy, the success rate of reperfusion for emergent large vessel occlusion (LVO) has significantly improved, but more achievements are still needed. In situ post-ischemic conditioning (IPC) is a modified reperfusion technique and a neuroprotective method. It is potentially promising for patients with acute ischemic stroke (AIS) and can improve the outcome; however, the IPC technique has not been well defined. MethodsThe definition and technical details of in situ post-ischemic conditioning using neurointerventional strategies were defined in this prospective cohort. Consecutive patients treated with the IPC technique between January 1, 2022, and Jun 30, 2023, were included in this study. Patients’ demographic and technical performance of the IPC procedure were recorded. Adverse events related to the IPC procedure were actively monitored and analyzed. ResultsIn total, 40 patients underwent IPC. Their mean age was 65 years (IQR, 34–83), and 72.5% were male. The median ASPECTS (Alberta Stroke Program Early CT Score) was 7. The median of NIHSS was 13. The preset IPC program was achieved in 95.0% of cases, with 0% procedure-related mortality and 2.5% morbidity. The incidence of procedure-related dissection was 0%. The incidence of thrombotic events was 2.5%. Extravasation of contrast media was recorded as a serious adverse event. One thrombotic event occurred in the LAA Group. However, there was no statistical difference in the incidence of adverse events between the LAA and non-LAA groups. The LAA and MCA groups had shorter IPC procedure times compared with non-LAA and ICA groups. ConclusionThe IPC technique is safe and feasible with an acceptable complication rate.【背景】随着血管内治疗（endovascular therapy）技术的进步，急性大血管闭塞（emergent large vessel occlusion，LVO）患者的再灌注成功率已显著提升，但仍存在进一步优化空间。原位缺血后适应（in situ post-ischemic conditioning，IPC）作为一种改良再灌注技术与神经保护方法，在急性缺血性卒中（acute ischemic stroke，AIS）患者中具备潜在应用价值，可改善患者预后，但目前该IPC技术尚未得到明确规范。 【方法】本前瞻性队列研究明确了采用神经介入策略实施的原位缺血后适应的定义与技术细节。研究纳入2022年1月1日至2023年6月30日期间连续接受IPC技术治疗的患者，记录患者的人口学特征与IPC操作的技术实施情况，并主动监测、分析IPC操作相关的不良事件。 【结果】本研究共纳入40例行IPC治疗的患者，患者平均年龄为65岁，四分位数间距（Interquartile Range，IQR）为34~83，其中男性占比72.5%。阿尔伯塔卒中项目早期CT评分（Alberta Stroke Program Early CT Score，ASPECTS）中位数为7，美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）中位数为13。95.0%的患者完成了预设IPC方案，操作相关死亡率为0%，并发症发生率为2.5%。操作相关动脉夹层发生率为0%，血栓事件发生率为2.5%，造影剂外渗被列为严重不良事件。大动脉粥样硬化（large artery atherosclerosis，LAA）组中发生1例血栓事件，但LAA组与非LAA组的不良事件发生率无统计学差异。大脑中动脉（middle cerebral artery，MCA）组与LAA组的IPC操作时长短于非LAA组与颈内动脉（internal carotid artery，ICA）组。 【结论】IPC技术安全可行，并发症发生率处于可接受范围。