From the Departments of Radiology (S.A.A., M.D., R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P.)
Neurology (S.A.A.).
AJNR Am J Neuroradiol. 2019 Aug;40(8):1356-1362. doi: 10.3174/ajnr.A6132. Epub 2019 Jul 25.
Adjunctive techniques to stent retriever thrombectomy include balloon-guide catheters and/or distal access catheters for aspiration. We describe a novel technique using a flexible, 6 French 088 distal guide sheath advanced past the skull base to augment mechanical thrombectomy. We studied the relative safety and efficacy of this technique in the setting of a combined stent retriever-distal access catheter aspiration thrombectomy protocol.
We performed a retrospective case-control study of intracranial internal carotid artery or M1-M2 middle cerebral artery occlusions requiring mechanical thrombectomy. Patients were divided into 2 groups based on thrombectomy techniques: conventional stent retriever with distal access catheter aspiration without (standard) and with adjunctive GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery (GUARD). Using propensity score matching, we compared procedural safety, reperfusion efficacy using the modified Thrombolysis in Cerebral Infarction scale and clinical outcomes with the modified Rankin Scale.
In comparing the GUARD (45 patients) versus standard (45 matched case controls) groups, there were no significant differences in demographics, NIHSS presentations, IV rtPA use, median onset-to-groin puncture times, procedural complications, symptomatic intracranial hemorrhage, or mortality. The GUARD group demonstrated significantly higher successful mTICI ≥2b reperfusion rates (98% versus 80%, = .015) and improved functional mRS ≤2 outcomes (67% versus 43%, = .04), with independent effects of the GUARD technique confirmed in a multivariable logistic regression model.
The GUARD technique during mechanical thrombectomy with combined stent retrieval-distal access catheter aspiration is safe and effective in improving reperfusion and clinical outcomes.
支架取栓术的辅助技术包括球囊引导导管和/或远端抽吸导管。我们描述了一种使用灵活的 6Fr 088 远端导引导管穿过颅底以增强机械血栓切除术的新技术。我们研究了这种技术在联合支架取栓-远端抽吸导管抽吸血栓切除术方案中的相对安全性和有效性。
我们对需要机械血栓切除术的颅内颈内动脉或 M1-M2 大脑中动脉闭塞患者进行了回顾性病例对照研究。根据血栓切除术技术，患者分为两组：不使用（标准）和使用附加导引导管推进和远端岩下海绵窦内颈动脉抽吸的传统支架取栓联合抽吸（GUARD）。使用倾向评分匹配，我们比较了两组的手术安全性、使用改良脑梗死溶栓量表评估的再灌注效果和使用改良Rankin 量表评估的临床结局。
比较 GUARD 组（45 例）和标准组（45 例匹配病例对照），两组在人口统计学、NIHSS 表现、IV rtPA 使用、从发病到股动脉穿刺的中位时间、手术并发症、症状性颅内出血或死亡率方面无显著差异。GUARD 组显示出更高的成功 mTICI≥2b 再灌注率（98%对 80%， =.015）和改善的功能 mRS≤2 结局（67%对 43%， =.04），GUARD 技术的独立效果在多变量逻辑回归模型中得到证实。
在联合支架取栓-远端抽吸导管抽吸的机械血栓切除术中，GUARD 技术是安全有效的，可提高再灌注和临床结局。
