From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (F.F., H.L., G.B., J.N., M.B., T.D., J.F., C.B.), University Medical Center Hamburg-Eppendorf, Germany.
Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany (M.D.-C., G.T.), University Medical Center Hamburg-Eppendorf, Germany..
Stroke. 2018 Oct;49(10):2523-2525. doi: 10.1161/STROKEAHA.118.022737.
Background and Purpose- In acute ischemic stroke, mechanical thrombectomy allows flow restoration in the majority of cases. In case of an unsuccessful retrieval, little is known about how many retrieval attempts should be performed before stopping the procedure. This study assessed the recanalization rate and clinical outcome per retrieval maneuver. Methods- In this analysis, 330 patients with acute large vessel occlusion treated exclusively with stentrieval devices were included. Successful recanalization was defined as Thrombolysis in Cerebral Infarction 2b-3, a good clinical outcome was defined as modified Rankin Scale at 90 days of ≤2. Results- The median number of retrieval attempts was 1 (interquartile range, 1-2, maximum 8). Recanalization rates per retrieval attempt were highest for the first retrieval (46.8%) and lowest for the fifth retrieval (22.7%). After 3 retrieval attempts, 67.9% of patients were successfully recanalized. Patients with 1 to 3 retrieval attempts had higher rates of good clinical outcome (28.9% versus 7.4%; P=0.018). The number of passes was an independent negative predictor of good clinical outcome (adjusted odds ratio, 0.65; 95% CI, 0.435-0.970; P=0.035). Conclusions- Two-thirds of occlusions were successfully recanalized with up to 3 retrieval attempts. Further attempts had good recanalization rates, but the rate of favorable clinical outcome did not improve.
背景与目的- 在急性缺血性脑卒中，机械取栓术可使大多数患者的血流得到恢复。如果取栓失败，对于应在多少次取栓尝试后停止该操作，目前知之甚少。本研究评估了每次取栓尝试的再通率和临床转归。方法- 本分析纳入了 330 例仅采用支架取栓装置治疗的急性大血管闭塞患者。成功再通定义为血栓切除术溶栓分级（Thrombolysis in Cerebral Infarction）2b-3，良好的临床转归定义为 90 天时改良 Rankin 量表评分≤2。结果- 取栓尝试的中位数为 1 次（四分位距，1-2，最大 8 次）。首次取栓的再通率最高（46.8%），第五次取栓的再通率最低（22.7%）。进行 3 次取栓后，67.9%的患者实现再通。1-3 次取栓的患者具有更高的良好临床转归率（28.9%对 7.4%；P=0.018）。取栓次数是良好临床转归的独立负预测因素（调整优势比，0.65；95%置信区间，0.435-0.970；P=0.035）。结论- 多达 3 次取栓尝试可使三分之二的闭塞实现再通。进一步的取栓尝试可获得良好的再通率，但临床结局的改善并无提高。
