Sivan-Hoffmann Rotem, Gory Benjamin, Armoiry Xavier, Goyal Mayank, Riva Roberto, Labeyrie Paul Emile, Lukaszewicz Anne-Claire, Lehot Jean-Jacques, Derex Laurent, Turjman Francis
FHU IRIS, Department of Interventional Neuroradiology, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, Bron, France.
Université Claude Bernard lyon 1, Lyon, France.
Eur Radiol. 2017 Jan;27(1):247-254. doi: 10.1007/s00330-016-4338-y. Epub 2016 Apr 16.
To assess the efficacy and safety profile of stent-retriever thrombectomy (SRT) in acute anterior ischemic stroke patients with tandem occlusion.
Using the MEDLINE database, we conducted a systematic review and meta-analysis of all studies that included patients with acute ischemic stroke attributable to tandem occlusion who received treatment with SRT between November 2010 and May 2015.
The literature search identified 11 previous studies involving a total of 237 subjects out of whom 193 (81.4 %) were treated with acute stent placement for the extracranial internal carotid artery occlusion. Mean initial NIHSS score was 17, and median time from onset to recanalization was 283.5 min. Mean intravenous thrombolysis rate was 63.8 %. In the meta-analysis, the recanalization rate reached 81 % (95 % CI, 73-89). Meta-analysis of clinical outcomes showed a pooled estimate of 44 % (95 % CI, 33-55; 10 studies) for favourable outcome, 13 % (95 % CI, 8-20; 10 studies) for mortality, and 7 % (95 % CI, 2-13; eight studies) for symptomatic intracranial haemorrhage.
SRT with emergency carotid stenting is associated with acceptable safety and efficacy in acute anterior stroke patients with tandem occlusion compared to natural history. However, the best modality to treat proximal stenosis is based on an individual case basis.
• Stent retriever thrombectomy of tandem occlusion is efficient and safe. • Emergent carotid stenting during thrombectomy increase symptomatic intracranial haemorrhage without impact mortality. • Thrombectomy of tandem anterior circulation occlusion may be the first therapeutic option.
评估支架取栓术（SRT）治疗急性前循环串联闭塞性缺血性脑卒中患者的疗效和安全性。
利用MEDLINE数据库，我们对2010年11月至2015年5月期间接受SRT治疗的急性串联闭塞性缺血性脑卒中患者的所有研究进行了系统评价和荟萃分析。
文献检索确定了11项既往研究，共纳入237例患者，其中193例（81.4%）因颅外颈内动脉闭塞接受了急性支架置入治疗。初始美国国立卫生研究院卒中量表（NIHSS）评分均值为17分，从发病到再通的中位时间为283.5分钟。静脉溶栓平均率为63.8%。荟萃分析显示，再通率达到81%（95%CI，73 - 89）。临床结局的荟萃分析显示，有利结局的汇总估计为44%（95%CI，33 - 55；10项研究），死亡率为13%（95%CI，8 - 20；10项研究），症状性颅内出血为7%（95%CI，2 - 13；8项研究）。
与自然病程相比，SRT联合急诊颈动脉支架置入术治疗急性前循环串联闭塞性脑卒中患者具有可接受的安全性和疗效。然而，治疗近端狭窄的最佳方式应根据个体情况而定。
• 串联闭塞的支架取栓术高效且安全。• 取栓术中急诊颈动脉支架置入增加症状性颅内出血，但不影响死亡率。• 串联前循环闭塞的取栓术可能是首选治疗方案。
