Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, AP-HP, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
Department of Vascular Neurology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.
Clin Neuroradiol. 2018 Dec;28(4):553-562. doi: 10.1007/s00062-017-0594-8. Epub 2017 May 15.
Most recent guidelines recommend the use of stent retriever devices in endovascular treatment of acute ischemic stroke with large vessel occlusion (LVO). Recently published data reported convincing results with thromboaspiration devices such as the Penumbra System (Penumbra, Alameda, CA, USA) combined with supple reperfusion catheters by using the ADAPT (A Direct Aspiration First-Pass Thrombectomy) technique. The aim of this study was to report our initial experience with the 3MAX (3.8 F) reperfusion catheter for the recanalization of distal intracranial arteries.
From August 2015 to December 2016, 32 consecutive patients (16 females, 50%; mean age = 67.4 ± 18.7 years, range: 22-91) for 38 distal occlusions underwent mechanical thrombectomy (MT) by thromboaspiration using the 3MAX. Median NIHSS score at admission was 14 (IQR: 9-19). Distal occlusions were distributed as follows: M2 (n: 23), M3 (n: 6), P1 (n: 3), P2 (n: 2), P3 (n: 2), A3 segment (n: 1) and superior cerebellar artery (n: 1).
In 1/38 (2.6%) target artery, the 3MAX could not be navigated. Of the 37 (59.5%) remaining arteries, 22 were successfully reperfused (TICI 2b/3) after ADAPT with the 3MAX alone. Additional stent retriever thrombectomy allowed a 76.3% final reperfusion rate. Good functional outcome (mRS ≤2) was obtained in 45.5% of patients at 3 months. Three (9.4%) 3MAX-related complications occurred: 2 emboli to new territory (ENT) and one vascular perforation.
The 3MAX is well-navigable in distal arteries making it useful as a frontline technique. However, the reperfusion rate with the 3MAX catheter alone seems lower than the ones reported with stent retrievers for such distal occlusions.
最新指南建议在血管内治疗伴有大血管闭塞（LVO）的急性缺血性脑卒中时使用支架取栓装置。最近公布的数据显示，血栓抽吸装置（如 Penumbra 系统[Penumbra，Alameda，CA，USA]）结合使用 ADAPT（直接抽吸首次通过血栓切除术）技术的柔软再灌注导管，取得了令人信服的结果。本研究旨在报告我们使用 3MAX（3.8F）再灌注导管对远端颅内动脉再通的初步经验。
2015 年 8 月至 2016 年 12 月，32 例连续患者（16 例女性，50%；平均年龄=67.4±18.7 岁，范围：22-91 岁）共 38 例远端闭塞行血栓抽吸机械取栓术（MT），使用 3MAX。入院时 NIHSS 评分中位数为 14（IQR：9-19）。远端闭塞分布如下：M2（n=23）、M3（n=6）、P1（n=3）、P2（n=2）、P3（n=2）、A3 段（n=1）和小脑上动脉（n=1）。
在 38 例目标血管中，有 1/38（2.6%）例 3MAX 无法进行导航。在 37 例（59.5%）剩余的血管中，22 例经 ADAPT 联合 3MAX 单独治疗后成功再通（TICI 2b/3）。进一步使用支架取栓器血栓切除术可使最终再通率达到 76.3%。3 个月时，45.5%的患者获得良好的功能结局（mRS≤2）。3 例（9.4%）发生与 3MAX 相关的并发症：2 例新发血管区域（ENT）栓塞和 1 例血管穿孔。
3MAX 可在远端血管内顺利导航，因此作为一种一线技术非常有用。然而，单独使用 3MAX 导管的再通率似乎低于支架取栓器治疗此类远端闭塞的再通率。
