Liebig T, Gralla J, Schroth Gerhard
Department of Neuroradiology, University Hospital of Cologne, Cologne, Germany.
Institute for diagnostic and interventional Neuroradiology, Inselspital - University Hospital, 3010, Bern, Switzerland.
Clin Neuroradiol. 2015 Oct;25 Suppl 2:299-306. doi: 10.1007/s00062-015-0435-6. Epub 2015 Jul 28.
Mechanical thrombectomy provides higher recanalization rates than intravenous or intra-arterial thrombolysis. Finally this has been shown to translate into improved clinical outcome in six multicentric randomized controlled trials. However, within cohorts the clinical outcomes may vary, depending on the endovascular techniques applied. Systems aiming mainly for thrombus fragmentation and lacking a protection against distal embolization have shown disappointing results when compared to recent stent-retriever studies or even to historical data on local arterial fibrinolysis. Procedure-related embolic events are usually graded as adverse events in interventional neuroradiology. In stroke, however, the clinical consequences of secondary emboli have so far mostly been neglected and attributed to progression of the stroke itself. We summarize the evolution of instruments and techniques for endovascular, image-guided, microneurosurgical recanalization in acute stroke, and discuss how to avoid procedure-related embolic complications.
机械取栓术比静脉或动脉内溶栓术具有更高的再通率。最终，在六项多中心随机对照试验中已证明这能转化为更好的临床结果。然而，在不同队列中，临床结果可能会有所不同，这取决于所应用的血管内技术。与近期的支架取栓器研究相比，甚至与局部动脉溶栓的历史数据相比，主要旨在血栓破碎且缺乏远端栓塞防护的系统显示出令人失望的结果。在介入神经放射学中，与手术相关的栓塞事件通常被列为不良事件。然而，在中风方面，继发性栓子的临床后果迄今为止大多被忽视，并归因于中风本身的进展。我们总结了急性中风中血管内、图像引导、显微神经外科再通的器械和技术的演变，并讨论如何避免与手术相关的栓塞并发症。
