Mokin Maxim, Kan Peter, Sivakanthan Sananthan, Veznedaroglu Erol, Binning Mandy J, Liebman Kenneth M, Jethwa Pinakin R, Turner Raymond D, Turk Aquilla S, Natarajan Sabareesh K, Siddiqui Adnan H, Levy Elad I
Department of Neurosurgery and Neurology, University of South Florida, Tampa, Florida, USA.
Capital Health, Trenton, New Jersey, USA.
J Neurointerv Surg. 2016 Mar;8(3):240-3. doi: 10.1136/neurintsurg-2014-011586. Epub 2015 Jan 29.
Endovascular treatment of wake-up strokes (WUS) has been previously described, mostly with the use of pharmacological thrombolysis or first generation thrombectomy devices.
To describe outcomes of WUS treated with modern endovascular therapy since the Food and Drug Administration approval of stent retrievers, and to identify predictors of good clinical outcome in this population of stroke patients.
We performed a multicenter retrospective analysis of consecutive patients with WUS who underwent thrombectomy with stent retrievers Trevo (Stryker, Kalamazoo, Michigan, USA) and Solitaire FR (Covidien, Irvine, California, USA), or primary aspiration thrombectomy. We correlated favorable clinical outcomes with demographic, clinical, and technical characteristics.
52 patients were included in this study; 46 (88%) cases were treated with stent retrievers and 6 (12%) were treated with primary aspiration thrombectomy alone. Successful recanalization (Thrombolysis in Cerebral Infarction (TICI) 2b/3) was achieved in 36 (69%) patients. Favorable clinical outcome at 3 months, defined as a modified Rankin Scale score of 0-2, was achieved in 25 (48%) patients. Duration of intervention <30 min and its success, defined as TICI 2b/3 recanalization, were strong predictors of favorable clinical outcome at 90 days (p<0.001 and p<0.0001, respectively).
Our study indicates that endovascular treatment of WUS with stent retrievers and aspiration thrombectomy is safe and effective.
先前已有关于醒后卒中（WUS）血管内治疗的描述，大多采用药物溶栓或第一代取栓装置。
描述自美国食品药品监督管理局批准支架取栓器以来，采用现代血管内治疗的WUS患者的治疗结果，并确定该组卒中患者良好临床结局的预测因素。
我们对连续接受使用Trevo（史赛克公司，美国密歇根州卡拉马祖）和Solitaire FR（柯惠医疗公司，美国加利福尼亚州欧文）支架取栓器进行取栓术或单纯一次抽吸取栓术的WUS患者进行了多中心回顾性分析。我们将良好的临床结局与人口统计学、临床和技术特征进行了关联分析。
本研究纳入了52例患者；46例（88%）采用支架取栓器治疗，6例（12%）仅采用一次抽吸取栓术治疗。36例（69%）患者实现了成功再通（脑梗死溶栓（TICI）2b/3级）。3个月时良好的临床结局定义为改良Rankin量表评分为0 - 2分，25例（48%）患者达到此标准。干预持续时间<30分钟及其成功（定义为TICI 2b/3级再通）是90天时良好临床结局的有力预测因素（分别为p<0.001和p<0.0001）。
我们的研究表明，使用支架取栓器和抽吸取栓术对WUS进行血管内治疗是安全有效的。
