Department of Neurology, Goethe University, Frankfurt, Germany.
Cerebrovasc Dis. 2011;32(3):211-8. doi: 10.1159/000328814. Epub 2011 Aug 23.
The clinical benefit of mechanical recanalization procedures for acute stroke is still a matter of debate. We report the clinical and imaging results of 34 consecutive patients, focusing on time aspects (i.e. vessel occlusion time and procedure duration).
During a 3-year period, 34 stroke patients with large-vessel occlusion (anterior circulation, n = 19; posterior circulation, n = 15) were treated with several mechanical recanalization devices with (n = 17) or without prior intravenous thrombolysis. Clinical and imaging data before (NIHSS) and after treatment [(mRS) 3 and 6-30 months] were analyzed. The angiographic outcome (TIMI score), complication rates, and procedural issues (i.e. procedure duration and vessel occlusion time) were assessed.
The median NIHSS on admission was 17. Successful recanalization (TIMI 2 and 3) was achieved in 23 (68%) patients. The median time from symptom onset to recanalization was 330 min, and the median time from angiography to recanalization was 101 min. Six (18%) patients had a good clinical outcome (3-month mRS ≤2), and 10 (29%) died. The vessel occlusion time was significantly shorter in patients with a good compared to poor clinical outcome (247 vs. 348 min, p = 0.024). In the subgroup of anterior circulation stroke, successful recanalization, and no symptomatic intracranial hemorrhage (n = 11), there was a strong correlation between vessel occlusion time and clinical outcome (r = 0.711, p = 0.014).
The rate of vessel recanalization with endovascular therapy is promising. Nevertheless, the long-term clinical outcome is still disadvantageous in the majority of patients, presumably due to too long vessel occlusion times. Better strategies for patient selection and optimization of recanalization strategies (i.e. shorter time intervals to vessel patency) are warranted.
机械再通程序对急性中风的临床获益仍存在争议。我们报告了 34 例连续患者的临床和影像学结果，重点关注时间方面（即血管闭塞时间和手术时间）。
在 3 年期间，34 例患有大血管闭塞的中风患者（前循环，n = 19；后循环，n = 15）接受了几种机械再通装置的治疗，其中（n = 17）或不进行静脉内溶栓治疗。分析了治疗前后的临床和影像学数据（NIHSS）和治疗后[（mRS）3 和 6-30 个月]。评估了血管造影结果（TIMI 评分）、并发症发生率和程序问题（即手术时间和血管闭塞时间）。
入院时 NIHSS 的中位数为 17。23 例（68%）患者实现了再通（TIMI 2 和 3）。从症状发作到再通的中位时间为 330 分钟，从血管造影到再通的中位时间为 101 分钟。6 例（18%）患者有良好的临床结果（3 个月 mRS ≤2），10 例（29%）死亡。与临床预后不良的患者相比，血管闭塞时间在临床预后良好的患者中明显缩短（247 分钟与 348 分钟，p = 0.024）。在前循环中风亚组中（n = 11），成功再通和无症状性颅内出血患者中，血管闭塞时间与临床结果之间存在很强的相关性（r = 0.711，p = 0.014）。
血管内治疗的血管再通率很有希望。然而，在大多数患者中，长期临床结果仍然不利，可能是由于血管闭塞时间过长。需要更好的患者选择策略和再通策略的优化（即达到血管通畅的时间间隔更短）。
