From the Department of Radiology (D.-H.K., Y.-W.K., Y.-S.K.), Department of Neurology (Y.-W.K., Y.-H.H.), and Department of Neurosurgery (D.-H.K., J.P., J.-H.H.), Kyungpook National University Hospital, Daegu, Republic of Korea.
Stroke. 2013 Dec;44(12):3577-9. doi: 10.1161/STROKEAHA.113.002673. Epub 2013 Sep 10.
We introduce the concept of a switching strategy for mechanical thrombectomy with period-to-period analysis. In period 1, forced arterial suction thrombectomy with a Penumbra reperfusion catheter was performed, even in difficult cases; in period 2, forced arterial suction thrombectomy was initially performed, with switching to Solitaire in difficult cases.
We analyzed 135 consecutive patients treated with mechanical thrombectomy with acute large vessel occlusion in the anterior circulation, 61 from period 1 and 74 from period 2. We defined difficult case for both periods as ≥3 failed attempts at recanalization.
Period 2 showed a trend for better angiographic outcome of Thrombolysis in Cerebral Infarction 2b-3 (73.8%, period 1 versus 85.1%, period 2; P=0.10). In interperiod subgroup analysis of difficult cases, switching significantly outperformed nonswitching in Thrombolysis in Cerebral Infarction 2b-3 recanalization (52.7% versus 82.9%; P=0.030). Differences in puncture-to-recanalization time, symptomatic intracranial hemorrhage incidence, and procedure-related complications were not statistically significant.
A switching strategy using 2 mechanical thrombectomy techniques (forced arterial suction thrombectomy to Solitaire) may harbor better angiographic outcomes than a 1 technique only strategy (forced arterial suction thrombectomy).
我们介绍了一种机械血栓切除术的切换策略，即周期性分析。在第 1 阶段，即使在困难的情况下，也采用 Penumbra 再灌注导管进行强制动脉抽吸血栓切除术；在第 2 阶段，最初采用强制动脉抽吸血栓切除术，如果遇到困难情况则切换至 Solitaire。
我们分析了 135 例接受机械血栓切除术治疗前循环急性大血管闭塞的连续患者，其中 61 例来自第 1 阶段，74 例来自第 2 阶段。我们将两个时期的困难病例均定义为≥3 次再通尝试失败。
第 2 阶段显示出更好的血管造影结果的趋势，即血栓切除术的脑梗死 2b-3 级（第 1 阶段为 73.8%，第 2 阶段为 85.1%；P=0.10）。在困难病例的跨期亚组分析中，与不切换相比，切换在血栓切除术的脑梗死 2b-3 级再通方面表现更好（52.7%比 82.9%；P=0.030）。穿刺至再通时间、症状性颅内出血发生率和与操作相关的并发症差异无统计学意义。
与仅使用 1 种机械血栓切除术技术（强制动脉抽吸血栓切除术）相比，使用 2 种机械血栓切除术技术（强制动脉抽吸血栓切除术至 Solitaire）的切换策略可能具有更好的血管造影结果。
