Ohshima Tomotaka, Ishikawa Kojiro, Goto Shunsaku, Yamamoto Taiki
Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
World Neurosurg. 2017 Nov;107:657-662. doi: 10.1016/j.wneu.2017.08.105. Epub 2017 Aug 24.
Although endovascular approaches for acute ischemic stroke have been developed, the appropriate selection and sequence of device application or other treatments is unclear. If information about the clot quality can be obtained before the selection of devices, fast recanalization with a suitable device and strategy can be achieved. We studied the relationship between clot quality and the configuration of a microguidewire during endovascular thrombectomy.
This prospective single-center study included all patients who were admitted for acute ischemic stroke between October 2015 and June 2017 and underwent emergency endovascular thrombectomy. We used a modified pigtail-shaped microguidewire to penetrate clots. The configurations under radiograph were distinguished into 2 types and assessed according to collected clot appearance and quality.
A total of 54 patients underwent acute endovascular thrombectomy. When the tip of the microguidewire became stuck against a clot during penetration, the clot was solid and hard, with statistical significance (P = 0.013).
Our results showed that we can select a suitable device and strategy for fast recanalization according to information about clot quality obtained using the modified pigtail-shaped microguidewire.
尽管急性缺血性卒中的血管内治疗方法已经得到发展，但器械应用或其他治疗的合适选择及顺序尚不清楚。如果在选择器械之前能够获得有关血栓质量的信息，那么采用合适的器械和策略就可以实现快速再通。我们研究了血管内血栓切除术期间血栓质量与微导丝形态之间的关系。
这项前瞻性单中心研究纳入了2015年10月至2017年6月期间因急性缺血性卒中入院并接受紧急血管内血栓切除术的所有患者。我们使用改良的猪尾形微导丝穿透血栓。根据X线片下的形态将其分为2种类型，并根据收集到的血栓外观和质量进行评估。
共有54例患者接受了急性血管内血栓切除术。当微导丝尖端在穿透过程中卡在血栓上时，血栓质地坚硬，具有统计学意义（P = 0.013）。
我们的结果表明，根据使用改良猪尾形微导丝获得的血栓质量信息，我们可以选择合适的器械和策略以实现快速再通。
