Department of Neurology, Chungnam National University Hospital and School of Medicine, Daejeon, Korea.
J Clin Neurol. 2013 Apr;9(2):91-6. doi: 10.3988/jcn.2013.9.2.91. Epub 2013 Apr 4.
We evaluated whether stent-assisted thrombectomy (SAT) is safer or more clinically beneficial than aggressive mechanical clot disruption (AMCD) for patients with acute intracranial artery occlusion.
We retrospectively analyzed the clinical data of 72 patients (33 with SAT and 39 with AMCD) who underwent intra-arterial thrombolysis for acute intracranial artery occlusions. Procedure parameters, clinical outcomes, and incidence of complications were compared between the SAT and AMCD groups.
The time interval to recanalization was shorter in SAT patients (69.2±39.6 minutes, mean±standard deviation) than in AMCD patients (94.4±48.0 minutes, p<0.05). Recanalization was achieved in more SAT patients (91%) than AMCD patients (80%), but with no statistically significance. Urokinase was used less frequently in SAT patients (21%) than in AMCD patients (92%, p<0.05), and the incidence of symptomatic hemorrhages was lower in SAT patients (3%) than in AMCD patients (18%, p<0.05). Device-related complications in SAT patients comprised two cases of stent fracture and one case of distal migration of a captured thrombus. The proportion of patients with good outcomes, defined as scores from 0 to 3 on the modified Rankin Scale, was similar in the two groups at discharge (SAT, 46%; AMCD, 39%), but significantly higher in the SAT group than in the AMCD group at 3 months (64% vs. 40%, p<0.05) and 6 months (67% vs. 42%, p<0.05) after discharge.
The outcomes and clinical parameters were better for SAT during thrombolytic procedures for acute intracranial artery occlusions than for AMCD for up to 6 months. However, some device-related complications occurred during stent interventions.
我们评估了支架辅助血栓切除术（SAT）与积极机械血栓破坏（AMCD）相比，对急性颅内动脉闭塞患者是否更安全或更具临床益处。
我们回顾性分析了 72 例接受动脉内溶栓治疗的急性颅内动脉闭塞患者（33 例接受 SAT，39 例接受 AMCD）的临床资料。比较了 SAT 和 AMCD 组之间的手术参数、临床结果和并发症发生率。
SAT 组患者的再通时间更短（69.2±39.6 分钟，均值±标准差），明显短于 AMCD 组（94.4±48.0 分钟，p<0.05）。SAT 组患者再通率（91%）高于 AMCD 组（80%），但无统计学意义。SAT 组患者较少使用尿激酶（21%），明显少于 AMCD 组（92%，p<0.05），SAT 组患者症状性出血发生率（3%）明显低于 AMCD 组（18%，p<0.05）。SAT 组患者的器械相关并发症包括 2 例支架断裂和 1 例捕获血栓远端迁移。出院时两组患者的良好预后比例（改良 Rankin 量表评分为 0-3 分）相似（SAT 组 46%，AMCD 组 39%），但 SAT 组在出院后 3 个月（64% vs. 40%，p<0.05）和 6 个月（67% vs. 42%，p<0.05）时明显更高。
在急性颅内动脉闭塞的溶栓治疗中，与 AMCD 相比，SAT 的结果和临床参数在 6 个月内更好。然而，在支架介入过程中发生了一些与器械相关的并发症。
