Colby Geoffrey P, Baharvahdat Humain, Mowla Ashkan, Young Richard, Shwe Yamin, Jahan Reza, Tateshima Satoshi, Szeder Viktor, Nour May, Vinuela Fernando, Duckwiler Gary
Department of Neurosurgery, University of California, Los Angeles, California, USA; Department of Radiology, University of California, Los Angeles, California, USA.
Department of Neurosurgery, University of California, Los Angeles, California, USA.
World Neurosurg. 2019 Mar;123:e747-e752. doi: 10.1016/j.wneu.2018.12.023. Epub 2018 Dec 19.
Extensive evidence supports mechanical thrombectomy using stentrievers (SR) for acute large vessel occlusion (aLVO). Aspiration is also used as a first pass or adjunct technique during clot removal. Here we report technical results from mechanical thrombectomy cases using SR alone, aspiration alone (AD), or a combination of SR and aspiration (SA) as a first pass for aLVO.
An institutional stroke database was reviewed for patients presenting to a single academic institution with anterior circulation aLVO and who were treated with mechanical thrombectomy from 2011 to 2017. Patients managed with SR alone, AD, or a combination of these 2 techniques (SA) were identified. The rate of successful recanalization after the first thrombectomy attempt was compared between the 3 groups.
A total of 353 patients were analyzed, including 215 in SR, 32 in AD, and 106 in SA groups. There was no significant difference for age and admission National Institutes of Health Stroke Scale between the groups. Successful recanalization rates after the first pass were 35.8% in the SR group, 34.4% in aspiration as a first pass technique, and 55.7% in SA, with a statistically significant higher rate of first pass success in the SA group (P = 0.002). Using balloon-guide catheter doubled the rate of successful first pass recanalization from 21.3% to 41.6% in the SR group (P = 0.005); however, the SA technique was more effective for first pass recanalization when compared with an SR and balloon-guide catheter combination (55.7% vs. 41.6%, P = 0.025).
The combination of SR and catheter aspiration can increase the rate of single pass successful recanalization compared with these techniques individually.
大量证据支持使用取栓支架（SR）治疗急性大血管闭塞（aLVO）。抽吸也被用作血栓清除过程中的首次通过或辅助技术。在此，我们报告单独使用SR、单独使用抽吸（AD）或SR与抽吸联合（SA）作为aLVO首次通过的机械取栓病例的技术结果。
回顾一个机构性卒中数据库，纳入2011年至2017年在单一学术机构就诊且接受机械取栓治疗的前循环aLVO患者。确定单独使用SR、AD或这两种技术联合（SA）治疗的患者。比较三组首次取栓尝试后的成功再通率。
共分析353例患者，包括SR组215例、AD组32例和SA组106例。各组间年龄和入院时美国国立卫生研究院卒中量表评分无显著差异。首次通过后的成功再通率在SR组为35.8%，抽吸作为首次通过技术时为34.4%，SA组为55.7%，SA组首次通过成功率在统计学上显著更高（P = 0.002）。在SR组中，使用球囊导引导管使首次通过成功再通率从21.3%提高了一倍至41.6%（P = 0.005）；然而，与SR和球囊导引导管联合相比，SA技术在首次通过再通方面更有效（55.7%对41.6%，P = 0.025）。
与单独使用这些技术相比，SR与导管抽吸联合可提高单次成功再通率。
