Division of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
AJNR Am J Neuroradiol. 2010 May;31(5):935-9. doi: 10.3174/ajnr.A1958. Epub 2010 Jan 14.
Use of the Merci retriever is increasing as a means to reopen large intracranial arterial occlusions. We sought to determine whether there is an optimum number of retrieval attempts that yields the highest recanalization rates and after which the probability of success decreases.
All consecutive patients undergoing Merci retrieval for large cerebral artery occlusions were prospectively tracked at a comprehensive stroke center. We analyzed ICA, M1 segment of the MCA, and vertebrobasilar occlusions. We compared the revascularization of the primary AOL with the number of documented retrieval attempts used to achieve that AOL score. For tandem lesions, each target lesion was compared separately on the basis of where the device was deployed.
We identified a total of 97 patients with 115 arterial occlusions. The median number of attempts per target vessel was 3, while the median final AOL score was 2. Up to 3 retrieval attempts correlated with good revascularization (AOL 2 or 3). When >or=4 attempts were performed, the end result was more often failed revascularization (AOL 0 or 1) and procedural complications (P = .006).
In our experience, 3 may be the optimum number of Merci retrieval attempts per target vessel occlusion. Four or more attempts may not improve the chances of recanalization, while increasing the risk of complications.
使用 Merci 取栓器来重新开通颅内大血管闭塞的情况越来越多。我们旨在确定是否存在一个最佳的取栓次数，能够获得最高的再通率，而超过这个次数后，成功的可能性就会降低。
在一个综合性卒中中心，我们前瞻性地追踪了所有连续接受 Merci 取栓治疗的大脑动脉大血管闭塞患者。我们分析了颈内动脉、MCA M1 段和椎基底动脉闭塞。我们将初级 AOL 的再通与达到该 AOL 评分所使用的有记录的取栓次数进行了比较。对于串联病变，根据器械部署的位置，对每个靶病变分别进行比较。
我们共确定了 97 例 115 处动脉闭塞患者。每个靶血管的平均取栓次数为 3 次，而平均最终 AOL 评分为 2 分。最多 3 次取栓与良好的再通（AOL 2 或 3）相关。当进行 >or=4 次取栓时，结果往往是再通失败（AOL 0 或 1）和手术并发症增加（P =.006）。
根据我们的经验，每个靶血管闭塞的 Merci 取栓尝试次数可能为 3 次。4 次或更多次的取栓尝试可能不会增加再通的机会，反而会增加并发症的风险。
