Department of Neuroradiology, Saarland University Hospital, Homburg, Germany.
AJNR Am J Neuroradiol. 2013 Nov-Dec;34(11):2184-6. doi: 10.3174/ajnr.A3565. Epub 2013 May 30.
Mechanical thrombectomy with stent retrievers in acute stroke has emerged as a promising new technique, with the highest recanalization rate of the therapeutic procedures available thus far. However, in up to 20% of the cases, mechanical thrombectomy with stent retrievers results in poor angiographic outcomes, with Thrombolysis in Cerebral Infarction scores ≤2a. The purpose of this study was to investigate whether thrombus attenuation on the initial CT scan can predict the angiographic outcome of the recanalization procedure in MCA occlusions.
The data of 70 patients with acute MCA occlusions who underwent endovascular treatment with stent retrievers in our department were included. We analyzed thrombus attenuations, angiographic outcome, and periprocedural thrombus fragmentation.
The mean thrombus attenuation was 49.8 ± 7.8 HU and the mean difference from the attenuation of the contralateral MCA was 9.9 ± 8.0 HU. There were no significant differences in the thrombus attenuations of occlusions that were successfully recanalized (modified Thrombolysis in Cerebral Infarction ≥2b) and those that were not. Neither were there significant correlations of thrombus attenuations and periprocedural thrombus fragmentations that occurred in 64.3%. We found a nonsignificantly higher rate of recanalizations with modified Thrombolysis in Cerebral Infarction ≥2b when the difference from the attenuation of the contralateral MCA was between 1-20 HU.
In contrast to results of other revascularization procedures as published in a recent study, the angiographic result of mechanical thrombectomy with stent retrievers is not predicted by thrombus attenuation.
机械取栓联合支架取栓术已成为一种有前途的急性脑卒中治疗新技术，是目前为止可采用的治疗方法中再通率最高的技术。然而，在多达 20%的病例中，机械取栓联合支架取栓术的血管造影结果较差，血栓切除术溶栓（Thrombolysis in Cerebral Infarction，TICI）评分≤2a。本研究旨在探讨初始 CT 扫描上的血栓衰减是否可以预测大脑中动脉（MCA）闭塞机械取栓术的血管造影结果。
回顾性分析了我院收治的 70 例接受支架取栓治疗的急性 MCA 闭塞患者的临床资料。分析了血栓衰减、血管造影结果和经皮腔内血管成形术过程中的血栓碎裂情况。
平均血栓衰减值为 49.8±7.8HU，与对侧 MCA 衰减值的平均差值为 9.9±8.0HU。成功再通（改良 TICI 评分≥2b）与未再通的闭塞部位血栓衰减值无显著差异。经皮腔内血管成形术过程中发生的血栓碎裂与血栓衰减值也无显著相关性（64.3%）。当与对侧 MCA 衰减值的差值在 1-20HU 时，改良 TICI 评分≥2b 的再通率有升高的趋势，但无统计学意义。
与最近一项研究中公布的其他再通术结果不同，支架取栓术的血管造影结果不能通过血栓衰减来预测。
