Uno Junji, Kameda Katsuharu, Otsuji Ryosuke, Ren Nice, Nagaoka Shintaro, Kazushi Maeda, Ikai Yoshiaki, Gi Hidefuku
Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan.
Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan.
World Neurosurg. 2018 Dec;120:e957-e961. doi: 10.1016/j.wneu.2018.08.196. Epub 2018 Sep 3.
We sought to examine the presentation, treatment, and outcomes of anterior cerebral artery (ACA) occlusions in patients undergoing mechanical thrombectomy (MT).
Two-hundred ninety-eight consecutive patients with large-vessel occlusion treated with MT were analyzed to identify all patients with acute ACA occlusion who underwent MT. The primary end point was defined as achieving a thrombolysis in cerebral infarction score ≥2b. The secondary end point included the 90-day modified Rankin Scale (mRS) score and symptomatic intracranial hemorrhage.
Nine patients with a median National Institutes of Health Stroke Scale score of 24 presented with acute ACA occlusion. The median time from onset to recanalization was 229 minutes. The ACA occlusion was a primary embolic occlusion in 5 patients, secondary to an interventional maneuver in 4 patients. Recanalization (thrombolysis in cerebral infarction ≥2b) was achieved in 9 of 9 patients (100%) without procedural complications. All patients had a 90-day mRS score ≥3, and 2 patients had an mRS score of 6. Two patients developed hemorrhagic infarction, and 1 patient had subarachnoid hemorrhage.
Although MT can be considered in patients with ACA occlusions, our data suggest that future clinical trials are needed to determine the efficacy of MT for ACA occlusions. Unfavorable outcomes in our study were considered to occur because of a larger infarct volume due to internal carotid artery, middle cerebral artery, and anterior cerebral artery territory infarction. The time from onset to recanalization was longer because MT was performed for occlusions of multiple arteries.
我们试图研究接受机械取栓术（MT）的患者大脑前动脉（ACA）闭塞的表现、治疗及预后。
对连续298例接受MT治疗的大血管闭塞患者进行分析，以确定所有接受MT治疗的急性ACA闭塞患者。主要终点定义为脑梗死溶栓评分≥2b。次要终点包括90天改良Rankin量表（mRS）评分和有症状的颅内出血。
9例美国国立卫生研究院卒中量表评分中位数为24分的患者出现急性ACA闭塞。从发病到再通的中位时间为229分钟。ACA闭塞在5例患者中为原发性栓塞性闭塞，4例患者继发于介入操作。9例患者中有9例（100%）实现再通（脑梗死溶栓≥2b），且无手术并发症。所有患者90天mRS评分≥3分，2例患者mRS评分为6分。2例患者发生出血性梗死，1例患者发生蛛网膜下腔出血。
尽管ACA闭塞患者可考虑MT，但我们的数据表明，未来需要进行临床试验以确定MT治疗ACA闭塞的疗效。我们研究中的不良预后被认为是由于颈内动脉、大脑中动脉和大脑前动脉区域梗死导致梗死体积较大。由于对多条动脉闭塞进行MT，从发病到再通的时间较长。
