Konstas Angelos Aristeidis, Minaeian Artin, Ross Ian B
Department of Radiology, Huntington Memorial Hospital, Pasadena, California.
Department of Neurology, Huntington Memorial Hospital, Pasadena, California.
J Stroke Cerebrovasc Dis. 2017 Jul;26(7):1609-1614. doi: 10.1016/j.jstrokecerebrovasdis.2017.02.024. Epub 2017 Mar 15.
There is lack of published studies on mechanical thrombectomy with stent retrievers for wake-up stroke (WUS).
To report the outcomes of WUS patients with large vessel occlusions, selected for intervention based on Alberta Stroke Program Early CT Score (ASPECTS) and treated with stent retrievers or primary aspiration thrombectomy.
Data were collected retrospectively for each consecutive WUS patient undergoing mechanical thrombectomy with a stent retriever or primary aspiration catheter between February 2015 and September 2016. ASPECTS ≥ 6 was used as the primary imaging criterion for offering thrombectomy in these WUS patients. Main outcomes were the in-hospital improvement in the National Institutes of Health Stroke Scale (NIHSS) and the occurrence of symptomatic hemorrhage.
Twelve patients were included in this study; 11 were treated with stent retrievers and 1 was treated with primary aspiration thrombectomy alone. Successful recanalization was achieved in 100% of the patients (33% thrombolysis in cerebral infarction [TICI] 2B and 67% TICI 3). Every patient experienced a reduction in the NIHSS during hospitalization, with a mean NIHSS decrease of 11.1 ± 5.1 points. There was a trend for a larger reduction in the NIHSS in patients with TICI 3 compared to TICI 2B recanalization. There was no symptomatic intracranial hemorrhage in our cohort.
For patients with WUS, careful selection of patients using ASPECTS may allow for safe interventions, with low risk of clinical deterioration, and no-periprocedural mortality. All our patients demonstrated a reduction in their NIHSS after the thrombectomy and clinical improvement.
关于使用支架取栓器治疗醒后卒中（WUS）的已发表研究较少。
报告基于阿尔伯塔卒中项目早期CT评分（ASPECTS）选择进行干预并使用支架取栓器或直接抽吸血栓切除术治疗的WUS大血管闭塞患者的治疗结果。
回顾性收集2015年2月至2016年9月期间连续接受支架取栓器或直接抽吸导管机械取栓的WUS患者的数据。ASPECTS≥6被用作这些WUS患者进行取栓治疗的主要影像学标准。主要结局指标为美国国立卫生研究院卒中量表（NIHSS）的院内改善情况及症状性出血的发生情况。
本研究共纳入12例患者；11例接受支架取栓器治疗，1例仅接受直接抽吸血栓切除术。所有患者均成功再通（33%为脑梗死溶栓[TICI]2B级，67%为TICI 3级）。每位患者住院期间NIHSS评分均降低，平均降低11.1±5.1分。与TICI 2B级再通患者相比，TICI 3级患者的NIHSS评分降低幅度有更大的趋势。本队列中未出现症状性颅内出血。
对于WUS患者，使用ASPECTS仔细选择患者可能实现安全干预，临床恶化风险低，且围手术期无死亡。我们所有患者在血栓切除术后NIHSS评分均降低，临床症状改善。
