Unit of Neuroimaging and Neurointervention (NINT), Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Viale M. Bracci 2, Siena, Italy.
Stroke Unit, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy.
Radiol Med. 2019 May;124(5):408-413. doi: 10.1007/s11547-018-0965-5. Epub 2018 Dec 13.
In acute stroke, distal cerebrovascular occlusions can be linked to severe clinical symptoms, and treatment by mechanical thrombectomy may have an important clinical impact. When intravenous fibrinolytic therapy is firmly contraindicated, it remains the only treatment option.
A total of 42 patients with isolated distal arterial occlusions and absolute contraindication for intravenous fibrinolytic therapy were retrospectively included. Mechanical thrombectomy was performed using Penumbra 4MAX or 3MAX aspiration catheters. When aspiration alone did not result in successful revascularization, a stent retriever was added.
Direct thromboaspiration was the first treatment option in all patients. 16.7% of cases required the additional use of a stent retriever. A TICI score ≥ 2b reperfusion at the end of the procedure was obtained in 76.2% and a Rankin Score of 2 or less at 90 days in 45.7%. Two hemorrhagic complications were observed.
Direct thromboaspiration appears a safe technique in acute isolated distal arterial occlusions. In a cohort of patients with absolute contraindication for intravenous fibrinolytic therapy, a significant percentage achieved good revascularization.
在急性脑卒中患者中，远端脑血管闭塞可能与严重的临床症状相关，机械取栓治疗可能具有重要的临床意义。当静脉溶栓治疗绝对禁忌时，机械取栓治疗仍然是唯一的治疗选择。
回顾性纳入 42 例孤立性远端动脉闭塞且绝对禁忌静脉溶栓治疗的患者。使用 Penumbra 4MAX 或 3MAX 抽吸导管进行机械取栓治疗。当单纯抽吸未能实现成功再通时，加用支架取栓器。
所有患者均首先选择直接血栓抽吸。16.7%的病例需要额外使用支架取栓器。76.2%的患者在治疗结束时获得 TICI 分级 2b 以上的再通，90 天的 Rankin 评分 2 级或更低者占 45.7%。观察到 2 例出血性并发症。
直接血栓抽吸在急性孤立性远端动脉闭塞中似乎是一种安全的技术。在绝对禁忌静脉溶栓治疗的患者队列中，很大比例的患者实现了良好的再通。
