Kim Yong-Won, Son Seungnam, Kang Dong-Hun, Hwang Yang-Ha, Kim Yong-Sun
Department of Neurology, Kyungpook National University Hospital, Daegu, Republic of Korea.
Department of Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea.
J Neurointerv Surg. 2017 Jul;9(7):626-630. doi: 10.1136/neurintsurg-2016-012466. Epub 2016 Jul 5.
To date there has been no direct comparison of two frequently used endovascular thrombectomy (EVT) methods (forced arterial suction thrombectomy (FAST) and stent retriever thrombectomy) in M2 occlusions. We review our experiences with EVT performed using FAST and stent retriever thrombectomy in such cases.
The subjects comprised 41 patients with an M2 occlusion who underwent EVT (25 with FAST, 16 with stent retriever thrombectomy). The patients' data were retrospectively analyzed to evaluate the technical characteristics and angiographic outcome of the two EVT techniques.
Thrombolysis In Cerebral Infarction (TICI) grades 2b-3 using the first chosen technique did not differ significantly between the two techniques (FAST 64.0% vs stent retriever thrombectomy 81.2%, p=0.305). Time from groin puncture to reperfusion was significantly shorter for stent retriever thrombectomy (53.0 vs 38.5 min; p=0.045). Distal embolization occurred in three cases (12.0%) in the FAST group and in four (26.7%) in the stent retriever group (p=0.362). However, the two techniques did not differ significantly in the final TICI 2b-3 rate (72.0% vs 87.5%; p=0.441). A frequent angiographic finding regarding the failure of FAST was that the M2 occlusion was located immediately after severe acute angulation between M1 and M2.
Stent retriever thrombectomy may provide faster reperfusion than FAST, while the FAST technique might be associated with lower distal embolization and a higher reperfusion rate for the first thrombectomy attempt, but without any significant difference in clinical outcome. When choosing the EVT method for M2 occlusions, consideration of the location of the occlusion and tortuosity between M1 and M2 might be helpful to achieve a better angiographic outcome.
迄今为止，尚未对两种常用的血管内血栓切除术（EVT）方法（强制动脉抽吸血栓切除术（FAST）和支架取栓术）在M2段闭塞中的应用进行直接比较。我们回顾了在此类病例中使用FAST和支架取栓术进行EVT的经验。
研究对象包括41例接受EVT的M2段闭塞患者（25例采用FAST，16例采用支架取栓术）。对患者数据进行回顾性分析，以评估两种EVT技术的技术特点和血管造影结果。
两种技术首次选择的技术达到脑梗死溶栓（TICI）2b - 3级的比例无显著差异（FAST为64.0%，支架取栓术为81.2%，p = 0.305）。支架取栓术从股动脉穿刺到再灌注的时间显著更短（53.0对38.5分钟；p = 0.045）。FAST组有3例（12.0%）发生远端栓塞，支架取栓组有4例（26.7%）发生远端栓塞（p = 0.362）。然而，两种技术在最终TICI 2b - 3级比例上无显著差异（72.0%对87.5%；p = 0.441）。关于FAST失败的常见血管造影表现是M2段闭塞位于M1和M2之间严重急性成角之后。
支架取栓术可能比FAST提供更快的再灌注，而FAST技术可能与较低的远端栓塞率和首次血栓切除术尝试时较高的再灌注率相关，但临床结果无显著差异。在选择M2段闭塞的EVT方法时，考虑闭塞位置以及M1和M2之间的迂曲情况可能有助于获得更好的血管造影结果。
