Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan; Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.
World Neurosurg. 2019 Nov;131:e495-e502. doi: 10.1016/j.wneu.2019.07.202. Epub 2019 Aug 2.
We investigated the efficacy of a combined approach with stent retriever-assisted aspiration catheter for distal intracranial vessel occlusion (distal combined technique [DCT]).
We evaluated consecutive patients with acute ischemic stroke with distal occlusion in anterior circulation, including occlusions of the M2/M3 or A2/A3 segments, who received endovascular therapy (EVT) in a single center. Modified Thrombolysis in Cerebral Infraction (mTICI) score including TICI 2C category, processing time from puncture to reperfusion, proportion of a favorable clinical outcome at discharge (modified Rankin Scale [mRS] score ≤2), and incidence of symptomatic intracranial hemorrhage (sICH) were compared between the DCT and single device approach technique (non-DCT) groups.
Of 65 patients, 28 were treated with EVT using the DCT and 37 were treated with EVT with a single device approach (non-DCT). In the DCT group, a higher reperfusion rate at the first pass (mTICI score ≥2B, 92% vs. 54%; P = 0.0008; mTICI score ≥2C, 71% vs. 16%; P < 0.0001; mTICI score 3, 57% vs. 14%; P = 0.0004) and shorter time from puncture to successful reperfusion (median, 31 vs. 43 minutes; P = 0.0006) were achieved, respectively. The final successful reperfusion rate was also higher in the DCT group than in the non-DCT group (mTICI score ≥2C, 85% vs. 51%; P = 0.004; mTICI score 3, 75% vs. 43%; P = 0.012), respectively. sICH occurred in 2 patients in the non-DCT group. Patients with mRS score ≤2 at discharge were more prevalent in the DCT than in the non-DCT group (57% vs. 27%, respectively; P = 0.021).
This retrospective analysis indicated that the DCT is a useful and safe strategy for patients with distal anterior intracranial vessel occlusion.
我们研究了支架取栓抽吸导管联合治疗颅内远端血管闭塞（远端联合技术 [DCT]）的疗效。
我们评估了在单一中心接受血管内治疗 (EVT) 的急性缺血性卒中伴前循环远端闭塞的连续患者，包括 M2/M3 或 A2/A3 段闭塞。改良脑梗死溶栓（mTICI）评分包括 TICI 2C 类、从穿刺到再灌注的处理时间、出院时良好临床结局的比例（改良 Rankin 量表 [mRS]评分≤2）和症状性颅内出血（sICH）的发生率在 DCT 与单一器械治疗技术（非 DCT）组之间进行了比较。
在 65 例患者中，28 例行 DCT 治疗，37 例行单一器械治疗（非 DCT）。在 DCT 组，首次通过时更高的再灌注率（mTICI 评分≥2B，92% vs. 54%；P=0.0008；mTICI 评分≥2C，71% vs. 16%；P<0.0001；mTICI 评分 3，57% vs. 14%；P=0.0004）和从穿刺到成功再灌注的时间更短（中位数，31 分钟 vs. 43 分钟；P=0.0006）。DCT 组的最终再灌注成功率也高于非 DCT 组（mTICI 评分≥2C，85% vs. 51%；P=0.004；mTICI 评分 3，75% vs. 43%；P=0.012）。非 DCT 组有 2 例发生 sICH。DCT 组出院时 mRS 评分≤2 的患者比例高于非 DCT 组（分别为 57% vs. 27%；P=0.021）。
这项回顾性分析表明，DCT 是治疗颅内远端前循环血管闭塞的一种有用且安全的策略。
