Singh Rakeshsingh K, Chafale Vishal Annaji, Lalla Rakesh Shyam, Panchal Keyurkumar Chandrakantbhai, Karapurkar Anil Pandurang, Khadilkar Satish Vasant, Ojha Pawan K, Godge Yogesh, Singh Rakesh K, Benny Rajesh
Department of Intervention Neurology and Endovascular Neurosurgery, Breach Candy Trust Hospital, Mumbai, Maharashtra, India.
Neurology, Fortis hospital, Mumbai, Maharashtra, India.
Ann Indian Acad Neurol. 2017 Jul-Sep;20(3):211-216. doi: 10.4103/aian.AIAN_158_17.
Mechanical thrombectomy (MT) is the most effective treatment in large vessel occlusion (LVO). We have analyzed our initial experience of MT of 137 patients in anterior circulation (AC) and posterior circulation (PC) LVO using Solitaire stent retriever device.
Retrospective cohort analysis of 112 AC and 25 PC acute ischemic strokes was done considering various baseline characteristics, risk factors, National Institute of Health Stroke Scale (NIHSS) change, revascularization rate, complications, and functional outcome at 3 months using modified Rankin score.
Out of 137 patients, occlusion was found in M1 segment (44.5%), carotid T occlusion (37.2%), and basilar artery (18.2%). Atrial fibrillation was important risk factor for Carotid T occlusion. 50.4% patients received intravenous thrombolysis. Baseline mean NIHSS in AC was 15.5 (±4.32), and PC was 19 (±5.5). Tandem lesions were noted in 14.6%. There was significant difference in mean door-to-needle time for AC and PC (220 ± 80.6 and 326 ± 191.8 min, respectively). Mean time to revascularization for AC (39.5 ± 14.1) and PC (42.2 ± 19.4) was similar. Procedural success (modified thrombolysis in cerebral infarction ≥2b) observed in AC and PC was 92.9% and 84%, respectively ( = 0.154). NIHSS at admission between 5 and 15 and immediate postprocedure NIHSS improvement >4 was associated with significant better clinical outcome at 3 months. Overall complication rate was about 15.3% including symptomatic intracranial hemorrhage in 8.1% and 6.6% deaths.
MT is safe treatment and equally effective for both AC and PC LVO. With careful patient selection, clinical outcome in PC was comparable to AC despite delayed presentation and higher baseline NIHSS.
机械取栓术（MT）是治疗大血管闭塞（LVO）最有效的方法。我们分析了使用Solitaire支架取栓装置对137例前循环（AC）和后循环（PC）LVO患者进行MT的初步经验。
对112例AC和25例PC急性缺血性卒中进行回顾性队列分析，考虑各种基线特征、危险因素、美国国立卫生研究院卒中量表（NIHSS）变化、血管再通率、并发症以及3个月时使用改良Rankin量表评估的功能结局。
137例患者中，闭塞发生在M1段（44.5%）、颈动脉T段闭塞（37.2%）和基底动脉（18.2%）。心房颤动是颈动脉T段闭塞的重要危险因素。50.4%的患者接受了静脉溶栓治疗。AC组基线平均NIHSS为15.5（±4.32），PC组为19（±5.5）。串联病变占14.6%。AC组和PC组的平均门到针时间有显著差异（分别为220±80.6分钟和326±191.8分钟）。AC组和PC组的平均再通时间相似（分别为39.5±14.1分钟和42.2±19.4分钟）。AC组和PC组观察到的手术成功率（改良脑梗死溶栓评分≥2b）分别为92.9%和84%（P = 0.154）。入院时NIHSS在5至15分之间且术后即刻NIHSS改善>4分与3个月时显著更好的临床结局相关。总体并发症发生率约为15.3%，包括8.1%的症状性颅内出血和6.6%的死亡。
MT是一种安全的治疗方法，对AC和PC LVO均同样有效。通过仔细选择患者，尽管PC患者就诊延迟且基线NIHSS较高，但其临床结局与AC患者相当。
