Kowoll Annika, Weber Anushe, Mpotsaris Anastasios, Behme Daniel, Weber Werner
Department of Radiology and Neuroradiology, University Medical Center Langendreer, Ruhr-University-Bochum, Bochum, Germany.
Department of Radiology and Neuroradiology, University Hospital of Cologne, University of Cologne, Cologne, Germany.
J Neurointerv Surg. 2016 Mar;8(3):230-4. doi: 10.1136/neurintsurg-2014-011520. Epub 2015 Jan 12.
Over the past decade, endovascular techniques for the treatment of acute ischemic stroke have emerged significantly. However, revascularization rates are limited at approximately 80%, and mechanical thrombectomy procedures still last about 1 h. Therefore, we investigated the novel direct aspiration first pass technique for its efficacy and safety.
Our neurointerventional database was screened for patients who received mechanical thrombectomy for acute ischemic stroke using the Penumbra 5MAX ACE aspiration catheter on an intention to treat basis between November 2013 and June 2014. Procedural data, including modified Thrombolysis in Cerebral Infarction (mTICI) score, procedural timings, and complications, as well as clinical data at admission and discharge, were analyzed.
54 patients received mechanical thrombectomy using the 5MAX ACE. Median age was 69 (39-94) years (54% were men). Baseline National Institutes of Health Stroke Scale (NIHSS) score was 15 (2-27) and 44/54 (81%) patients received intravenous thrombolysis. Vessel occlusion sites were 91% anterior circulation and 9% posterior circulation. A successful revascularization result (mTICI ≥2b) was achieved in 93% of cases whereas direct aspiration alone was successful in 30/54 (56%) cases; among these, median time from groin puncture to revascularization was 30 min (9-113). Symptomatic intracranial hemorrhage occurred in 2/54 (4%) patients, and embolization to new territories in 3/54 (6%). Median NIHSS at discharge was 6 (0-24); 46% of patients were independent at discharge.
The direct aspiration first pass technique proofed to be fast, effective, and safe. Promising revascularization results can be achieved quickly in more than 50% of patients using this technique as the firstline option. Nevertheless, stent retrievers are still warranted in approximately 40% of cases to achieve a favorable revascularization result.
在过去十年中，用于治疗急性缺血性卒中的血管内技术有了显著发展。然而，血管再通率约为80%，仍较为有限，且机械取栓手术时间仍约为1小时。因此，我们研究了新型直接抽吸首次通过技术的有效性和安全性。
在我们的神经介入数据库中筛选出2013年11月至2014年6月期间接受机械取栓治疗急性缺血性卒中的患者，这些患者在意向性治疗基础上使用Penumbra 5MAX ACE抽吸导管。分析了包括改良脑梗死溶栓（mTICI）评分、手术时间和并发症在内的手术数据，以及入院和出院时的临床数据。
54例患者使用5MAX ACE进行了机械取栓。中位年龄为69岁（39 - 94岁），男性占54%。基线美国国立卫生研究院卒中量表（NIHSS）评分为15分（2 - 27分），44/54（81%）的患者接受了静脉溶栓治疗。血管闭塞部位91%位于前循环，9%位于后循环。93%的病例实现了成功的血管再通结果（mTICI≥2b），而仅直接抽吸成功的病例有30/54（56%）；其中，从腹股沟穿刺到血管再通的中位时间为30分钟（9 - 113分钟）。2/54（4%）的患者发生了有症状颅内出血，3/54（6%）的患者出现了新梗死灶栓塞。出院时的中位NIHSS评分为6分（0 - 24分）；46%的患者出院时能够独立生活。
直接抽吸首次通过技术被证明是快速、有效且安全的。使用该技术作为一线选择，超过50%的患者能够迅速获得有前景的血管再通结果。然而，在大约40%的病例中，仍需要使用支架取栓器以实现良好的血管再通结果。
