Neurology, Neurosurgery and Radiology, Emory University School of Medicine/Marcus Stroke & Neuroscience Center - Grady Memorial Hospital, Atlanta, Georgia, USA.
Marcus Stroke & Neuroscience Center - Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA.
J Neurointerv Surg. 2020 Mar;12(3):279-282. doi: 10.1136/neurintsurg-2019-014990. Epub 2019 Jun 26.
Although aspiration and stent retriever thrombectomy perform similarly in proximal occlusions, no comparative series are available in distal occlusions. We aimed to compare the 3 mm Trevo Retriever against the 3MAX thromboaspiration catheter in distal arterial occlusions.
A single-center retrospective review of a prospectively maintained databank for patients treated with the 3 mm Trevo stent retriever or 3MAX thromboaspiration as the upfront approach for distal occlusions (middle cerebral artery mid/distal M2/M3, anterior cerebral artery A1/A2/A3 or posterior cerebral artery P1/P2) from January 2014 to July 2018 was performed. The primary outcome was the rate of distal occlusion first-pass reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3).
Of 1100 patients treated within the study period, 137 patients/144 different arteries were treated with the 3 mm Trevo (n=92) or 3MAX device (n=52). The groups had comparable demographics and baseline characteristics. There was a higher rate of first-pass mTICI 2b-3 reperfusion (62% vs 44%; p=0.03), a trend towards a higher rate of final mTICI 2b-3 reperfusion (84% vs 69%; p=0.05), and lower use of adjuvant therapy (15% vs 31%; p=0.03) with the 3 mm Trevo compared with the 3MAX. The median number of passes (p=0.46), frequency of arterial spasm (p=1.00), rates of parenchymal hematomas (p=0.22)/subarachnoid hemorrhage (p=0.37) in the territory of the approached vessel were similar across the two groups. The 90-day rate of good outcomes (45% vs 46% in the 3 mm Trevo and 3MAX groups, respectively; p=0.84) was comparable. Multivariable regression identified baseline NIH Stroke Scale (NIHSS) score (OR 0.9; 95% CI 0.8 to 0.97; p<0.01) and use of 3 mm Trevo (OR 2.2; 95% CI 1.1 to 4.6; p=0.02) independently associated with first-pass mTICI 2b-3 reperfusion.
In the setting of distal arterial occlusions, the 3 mm Trevo may lead to higher rates of first-pass reperfusion than direct 3MAX thromboaspiration. Lower NIHSS was found to be associated with improved reperfusion rates as observed in more proximal lesions. Further studies are warranted.
尽管抽吸和支架取栓在近端闭塞中效果相似，但在远端闭塞中尚无对照系列研究。我们旨在比较 3mm Trevo 取栓支架与 3MAX 血栓抽吸导管在远端动脉闭塞中的应用。
对 2014 年 1 月至 2018 年 7 月期间，采用 3mm Trevo 支架取栓或 3MAX 血栓抽吸导管作为治疗远端闭塞（大脑中动脉中段/远端 M2/M3、大脑前动脉 A1/A2/A3 或大脑后动脉 P1/P2）的一线治疗方法的前瞻性数据库中 137 例/144 条不同动脉的患者进行了单中心回顾性研究。主要终点是远端闭塞首次通过再灌注率（改良脑梗死溶栓（mTICI）2b-3）。
在研究期间接受治疗的 1100 例患者中，有 137 例/144 条不同动脉接受了 3mm Trevo（n=92）或 3MAX 装置治疗（n=52）。两组患者的人口统计学和基线特征相似。首次通过 mTICI 2b-3 再灌注率更高（62% vs 44%；p=0.03），最终 mTICI 2b-3 再灌注率有升高趋势（84% vs 69%；p=0.05），且辅助治疗使用率较低（15% vs 31%；p=0.03），与 3MAX 相比，3mm Trevo 组具有更高的再灌注率。两组之间穿过血管区域的动脉痉挛频率（p=1.00）、再灌注次数中位数（p=0.46）、脑实质血肿（p=0.22）/蛛网膜下腔出血（p=0.37）发生率相似。90 天的良好预后率（3mm Trevo 组和 3MAX 组分别为 45%和 46%；p=0.84）相当。多变量回归分析发现，基线 NIH 卒中量表（NIHSS）评分（OR 0.9；95%CI 0.8 至 0.97；p<0.01）和使用 3mm Trevo（OR 2.2；95%CI 1.1 至 4.6；p=0.02）与首次通过 mTICI 2b-3 再灌注独立相关。
在远端动脉闭塞的情况下，3mm Trevo 可能比直接使用 3MAX 血栓抽吸导管导致更高的首次通过再灌注率。发现较低的 NIHSS 与近端病变中观察到的更高的再灌注率相关。需要进一步研究。
