Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France.
Department of Diagnostic and Interventional Neuroradiology, University Hospital of Limoges, Limoges, France.
J Neurointerv Surg. 2019 Jul;11(7):625-629. doi: 10.1136/neurintsurg-2018-014380. Epub 2018 Nov 2.
Despite successful recanalization with mechanical thrombectomy (MT) for acute anterior ischemic stroke (AAIS), the number of passes may impact clinical outcome.We analyzed the impact of more than three MT passes (>3) in a trial that evaluated contact aspiration (CA) versus stent retriever (SR) as the first-line technique in AAIS.
We included patients with mTICI 2b/3 recanalization after MT for isolated intracranial occlusions. The primary outcome was the percentage of patients with a 90-day modified Rankin Scale (mRS)≤2. Secondary outcomes included overall distribution of 90-day mRS, parenchymal hematoma on 24 hours' brain imaging (PH), and 90-day mortality.
Among the 281 patients included and even after adjustment on time to recanalization, significantly more patients with >3 passes had PH than patients with ≤3 passes in multivariate analysis (adjusted OR, 3.62; 95% CI, 1.55 to 8.44). When the analyses were stratified according to CA vs. SR, patients with >3 passes had a stronger risk of PH than patients with ≤3 passes, only in the SR first-line-treated group (adjusted OR, 9.24; 95% CI, 2.65 to 32.13) and not in the CA first-line-treated group (adjusted RR, 1.73; 95% CI, 0.57 to 5.19). A negative association of borderline significance (P=0.07) between >3 passes and favorable outcome was observed only in SR first-line-treated patients (adjusted OR, 0.33; 95% CI, 0.09 to 1.11).
After three passes of SR and unlike for three passes of CA, there is an increased risk of PH and a trend toward a worse clinical outcome.
尽管急性前循环缺血性卒中（AAIS）患者通过机械取栓（MT）实现再通后，其再通次数可能会影响临床结局。我们分析了在一项评估接触抽吸（CA）与支架取栓（SR）作为 AAIS 一线治疗技术的试验中，使用超过 3 次 MT 取栓（>3）的影响。
我们纳入了接受 MT 治疗后实现 mTICI 2b/3 再通的孤立性颅内闭塞患者。主要结局为 90 天改良 Rankin 量表（mRS）评分≤2 的患者比例。次要结局包括 90 天 mRS 的总体分布、24 小时脑影像上的实质血肿（PH）和 90 天死亡率。
在 281 例纳入患者中，即使在校正再通时间后，多变量分析显示，再通次数>3 次的患者 PH 发生率显著高于再通次数≤3 次的患者（校正 OR，3.62；95%CI，1.55 至 8.44）。根据 CA 与 SR 进行分层分析时，仅在 SR 作为一线治疗的患者中，再通次数>3 次的患者发生 PH 的风险高于再通次数≤3 次的患者（校正 OR，9.24；95%CI，2.65 至 32.13），而在 CA 作为一线治疗的患者中则没有（校正 RR，1.73；95%CI，0.57 至 5.19）。仅在 SR 作为一线治疗的患者中观察到再通次数>3 次与有利结局之间存在边缘显著的负相关（P=0.07；校正 OR，0.33；95%CI，0.09 至 1.11）。
与 CA 三次再通不同，SR 三次再通后发生 PH 的风险增加，临床结局有恶化趋势。
