急性串联闭塞性卒中的血栓切除术：夹层与动脉粥样硬化病因的对比
Thrombectomy in Acute Stroke With Tandem Occlusions From Dissection Versus Atherosclerotic Cause.
作者信息
Gory Benjamin, Piotin Michel, Haussen Diogo C, Steglich-Arnholm Henrik, Holtmannspötter Markus, Labreuche Julien, Taschner Christian, Eiden Sebastian, Nogueira Raul G, Papanagiotou Panagiotis, Boutchakova Maria, Siddiqui Adnan, Lapergue Bertrand, Dorn Franziska, Cognard Christophe, Killer-Oberpfalzer Monika, Mangiafico Salvatore, Ribo Marc, Behme Daniel, Spiotta Alejandro M, Mazighi Mikael, Turjman Francis
机构信息
From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA (R.G.N., D.C.H.); Department of Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte/Bremen-Ost, Deutschland (P.P., M.B.); Department of Neurosurgery, State University of New York, Buffalo (A.H.S.); Department of Neurology, Stroke Center, Foch Hospital, Suresnes, France (B.L.); Department of Neuroradiology, University Hospital of Munich, Germany (F.D.); Department of Neuroradiology, University Hospital of Toulouse, France (C.C.); Department of Neuroradiology, Paracelsus Medical University Salzburg, Austria (M.K.); Department of Interventional Neuroradiology, Careggi University Hospital, Florence, Italy (S.M.); Department of Neurology, Hospital Vall D'Hebron, Barcelona, Spain (M.R.); Department of Neuroradiology, University Medical Center Göttingen, Germany (D.B.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.M.S.).
出版信息
Stroke. 2017 Nov;48(11):3145-3148. doi: 10.1161/STROKEAHA.117.018264. Epub 2017 Oct 3.
BACKGROUND AND PURPOSE
Tandem steno-occlusive lesions were poorly represented in randomized trials and represent a major challenge for endovascular thrombectomy in acute anterior circulation strokes. The impact of the cervical carotid lesion cause (ie, atherosclerotic versus dissection) on outcome of tandem patients endovascularly treated remains to be assessed.
METHODS
We retrospectively analyzed individual data of prospectively collected consecutive tandem patients treated with endovascular thrombectomy. The primary outcome was favorable outcome at 90 days (modified Rankin Scale score of 0-2). Secondary efficacy outcomes included successful reperfusion (modified Thrombolysis in Cerebrovascular Infarction scores of 2b-3), time to reperfusion, and safety outcomes encompassed procedural complications, symptomatic intracerebral hemorrhage, and 90-day mortality.
RESULTS
Among the 295 included patients, 65 had cervical carotid dissection and 230 had cervical carotid atherosclerotic cause. The rate of favorable outcome was 56.3% in the dissection group versus 47.6% in the atherosclerotic arm (center-, age-, and admission National Institutes of Health Stroke Scale-adjusted odds ratio, 1.08; 95% confidence interval, 0.50-2.30; =0.85). No significant differences were observed in secondary outcomes. The rates of successful reperfusion, symptomatic intracerebral hemorrhage, and 90-day mortality were 78.5% versus 74.5% (=0.13), 4.6% versus 5.2% (=1.0), and 7.8% versus 15.3% (=0.94) in the dissection versus atherosclerotic groups, respectively. The median procedural time was 76 minutes (interquartile range, 52-95 minutes) in the dissection group and 67 minutes (interquartile range, 45-98 minutes) in the atherosclerotic group (=0.24).
CONCLUSIONS
We found no differences in the outcomes of patients with anterior circulation tandem atherosclerotic and dissection lesions treated with endovascular thrombectomy. Further studies are warranted.
背景与目的
串联狭窄闭塞性病变在随机试验中的代表性不足，是急性前循环卒中血管内血栓切除术面临的一项重大挑战。颈段颈动脉病变病因（即动脉粥样硬化与夹层）对接受血管内治疗的串联病变患者预后的影响仍有待评估。
方法
我们回顾性分析了前瞻性收集的接受血管内血栓切除术的连续性串联病变患者的个体数据。主要结局为90天时的良好预后（改良Rankin量表评分为0 - 2分）。次要疗效结局包括成功再灌注（改良脑梗死溶栓评分2b - 3分）、再灌注时间，安全性结局包括手术并发症、症状性脑出血和90天死亡率。
结果
在纳入的295例患者中，65例为颈段颈动脉夹层，230例为颈段颈动脉动脉粥样硬化病因。夹层组良好预后率为56.3%，动脉粥样硬化组为47.6%（经中心、年龄和入院时美国国立卫生研究院卒中量表校正的优势比为1.08；95%置信区间为0.50 - 2.30；P = 0.85）。次要结局未观察到显著差异。夹层组与动脉粥样硬化组的成功再灌注率分别为78.5%和74.5%（P = 0.13），症状性脑出血率分别为4.6%和5.2%（P = 1.0），90天死亡率分别为7.8%和15.3%（P = 0.94）。夹层组的中位手术时间为76分钟（四分位间距为52 - 95分钟），动脉粥样硬化组为67分钟（四分位间距为45 - 98分钟）（P = 0.24）。
结论
我们发现接受血管内血栓切除术治疗的前循环串联动脉粥样硬化和夹层病变患者的预后无差异。有必要进行进一步研究。
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