From CHU Montpellier, Neuroradiology (G.G., P.M., I.M., J.F.V., C.R., O.E., A.B., V.C.).
AJNR Am J Neuroradiol. 2014 Apr;35(4):734-40. doi: 10.3174/ajnr.A3746. Epub 2013 Oct 24.
Stent retriever-assisted thrombectomy promotes high recanalization rates in acute ischemic stroke. Nevertheless, complications and failures occur in more than 10% of procedures; hence, there is a need for further investigation.
A total of 144 patients with ischemic stroke presenting with large-vessel occlusion were prospectively included. Patients were treated with stent retriever-assisted thrombectomy ± IV fibrinolysis. Baseline clinical and imaging characteristics were incorporated in univariate and multivariate analyses. Predictors of recanalization failure (TICI 0, 1, 2a), and of embolic and hemorrhagic complications were reported. The relationship between complication occurrence and periprocedural mortality rate was studied.
Median age was 69.5 years, and median NIHSS score was 18 at presentation. Fifty patients (34.7%) received stand-alone thrombectomy, and 94 (65.3%) received combined therapy. The procedural failure rate was 13.9%. Embolic complications were recorded in 12.5% and symptomatic intracranial hemorrhage in 7.6%. The overall rate of failure, complications, and/or death was 39.6%. The perioperative mortality rate was 18.4% in the overall cohort but was higher in cases of failure (45%; P = .003), embolic complications (38.9%; P = .0176), symptomatic intracranial hemorrhages (45.5%; P = .0236), and intracranial stenosis (50%; P = .0176). Concomitant fibrinolytic therapy did not influence the rate of recanalization or embolic complication, or the intracranial hemorrhage rate. Age was the only significant predictive factor of intracranial hemorrhage (P = .043).
The rate of perioperative mortality was significantly increased in cases of embolic and hemorrhagic complications, as well as in cases of failure and underlying intracranial stenoses. Adjunctive fibrinolytic therapy did not improve the recanalization rate or collateral embolic complication rate. The rate of symptomatic intracranial hemorrhage was not increased in cases of combined treatment.
支架取栓辅助血栓切除术可提高急性缺血性脑卒中患者的再通率。然而，仍有 10%以上的患者出现并发症和失败，因此需要进一步研究。
前瞻性纳入了 144 例表现为大血管闭塞的缺血性脑卒中患者。患者接受支架取栓辅助血栓切除术+静脉溶栓治疗。将基线临床和影像学特征纳入单因素和多因素分析。报告了血管再通失败（TICI 0、1、2a）、栓塞和出血并发症的预测因素。研究了并发症发生与围手术期死亡率之间的关系。
中位年龄为 69.5 岁，发病时 NIHSS 评分为 18 分。50 例（34.7%）患者接受单纯取栓治疗，94 例（65.3%）患者接受联合治疗。手术失败率为 13.9%。发生栓塞并发症 12.5%，症状性颅内出血 7.6%。总的失败、并发症和/或死亡率为 39.6%。全队列围手术期死亡率为 18.4%，但在失败病例中（45%；P=0.003）、栓塞性并发症病例中（38.9%；P=0.0176）、症状性颅内出血病例中（45.5%；P=0.0236）和颅内狭窄病例中（50%；P=0.0176）较高。同时接受纤维蛋白溶解治疗并未影响再通率、栓塞性并发症率或颅内出血率。年龄是颅内出血的唯一显著预测因素（P=0.043）。
发生栓塞和出血性并发症以及手术失败和潜在颅内狭窄的患者，围手术期死亡率显著增加。辅助纤维蛋白溶解治疗并未提高再通率或侧支栓塞性并发症率。联合治疗并未增加症状性颅内出血的发生率。
