Coutinho J M, Liebeskind D S, Slater L-A, Nogueira R G, Baxter B W, Levy E I, Siddiqui A H, Goyal M, Zaidat O O, Davalos A, Bonafé A, Jahan R, Gralla J, Saver J L, Pereira V M
From the Divisions of Neuroradiology (J.M.C., L.-A.S., V.M.P.).
Neurovascular Imaging Research Core and the University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California.
AJNR Am J Neuroradiol. 2016 Apr;37(4):667-72. doi: 10.3174/ajnr.A4591. Epub 2015 Nov 12.
Mechanical thrombectomy is beneficial for patients with acute ischemic stroke and a proximal anterior occlusion, but it is unclear if these results can be extrapolated to patients with an M2 occlusion. The purpose of this study was to examine the technical aspects, safety, and outcomes of mechanical thrombectomy with a stent retriever in patients with an isolated M2 occlusion who were included in 3 large multicenter prospective studies.
We included patients from the Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), Solitaire With the Intention For Thrombectomy (SWIFT), and Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME) studies, 3 large multicenter prospective studies on thrombectomy for ischemic stroke. We compared outcomes and technical details of patients with an M2 with those with an M1 occlusion. All patients were treated with a stent retriever. Imaging data and outcomes were scored by an independent core laboratory. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction score of 2b/3.
We included 50 patients with an M2 and 249 patients with an M1 occlusion. Patients with an M2 occlusion were older (mean age, 71 versus 67 years; P = .04) and had a lower NIHSS score (median, 13 versus 17; P < .001) compared with those with an M1 occlusion. Procedural time was nonsignificantly shorter in patients with an M2 occlusion (median, 29 versus 35 minutes; P = .41). The average number of passes with a stent retriever was also nonsignificantly lower in patients with an M2 occlusion (mean, 1.4 versus 1.7; P = .07). There were no significant differences in successful reperfusion (85% versus 82%, P = .82), symptomatic intracerebral hemorrhages (2% versus 2%, P = 1.0), device-related serious adverse events (6% versus 4%, P = .46), or modified Rankin Scale score 0-2 at follow-up (60% versus 56%, P = .64).
Endovascular reperfusion therapy appears to be feasible in selected patients with ischemic stroke and an M2 occlusion.
机械取栓术对急性缺血性卒中且存在近端前循环闭塞的患者有益，但这些结果能否外推至M2段闭塞的患者尚不清楚。本研究的目的是探讨在3项大型多中心前瞻性研究中纳入的孤立性M2段闭塞患者使用支架取栓器进行机械取栓的技术要点、安全性及疗效。
我们纳入了急性血管再通的Solitaire血流恢复取栓术（STAR）、取栓意向性Solitaire（SWIFT）以及作为主要血管内治疗的取栓意向性Solitaire（SWIFT PRIME）研究中的患者，这3项都是关于缺血性卒中取栓术的大型多中心前瞻性研究。我们比较了M2段闭塞患者与M1段闭塞患者的疗效及技术细节。所有患者均接受支架取栓器治疗。影像数据和疗效由独立的核心实验室进行评分。成功再灌注定义为改良脑梗死溶栓评分2b/3级。
我们纳入了50例M2段闭塞患者和249例M1段闭塞患者。与M1段闭塞患者相比，M2段闭塞患者年龄更大（平均年龄，71岁对67岁；P = 0.04），美国国立卫生研究院卒中量表（NIHSS）评分更低（中位数，13对17；P < 0.001）。M2段闭塞患者的手术时间略短，但差异无统计学意义（中位数，29分钟对35分钟；P = 0.41）。M2段闭塞患者使用支架取栓器的平均通过次数也略低，但差异无统计学意义（均值，1.4对1.7；P = 0.07）。成功再灌注率（85%对82%，P = 0.82）、症状性颅内出血发生率（2%对2%，P = 1.0）、与器械相关的严重不良事件发生率（6%对4%，P = 0.46）或随访时改良Rankin量表评分0 - 2级的比例（60%对56%，P = 0.64）均无显著差异。
血管内再灌注治疗在部分缺血性卒中和M2段闭塞的患者中似乎是可行的。
