Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität, Munich, Germany.
J Neurointerv Surg. 2020 Dec;12(12):1186-1193. doi: 10.1136/neurintsurg-2020-015938. Epub 2020 May 6.
Data on the frequency and outcome of repeated mechanical thrombectomy (MT) in patients with short-term re-occlusion of intracranial vessels is limited. Addressing this subject, we report our multicenter experience with a systematic review of the literature.
A retrospective analysis was conducted of consecutive acute stroke patients treated with MT repeatedly within 30 days at 10 tertiary care centers between January 2007 and January 2020. Baseline demographics, etiology of stroke, angiographic outcome and clinical outcome evaluated by the modified Rankin Scale (mRS) at 90 days were noted. Additionally, a systematic review of reports with repeated MT due to large vessel occlusion (LVO) recurrence was performed.
We identified 30 out of 7844 (0.4%) patients who received two thrombectomy procedures within 30 days due to recurrent LVO. Through systematic review, three publications of 28 participants met the criteria for inclusion. Combined, a total of 58 participants were analyzed: cardioembolic events were the most common etiology for the first (65.5%) and second LVO (60.3%), respectively. Median baseline NIHSS (National Institutes of Health Stroke Scale) was 13 (IQR 8-16) before the first MT and 15 (IQR 11-19) before the second MT (p=0.031). Successful reperfusion was achieved in 91.4% after the first MT and in 86.2% patients after the second MT (p=0.377). The rate of functional independence (mRS 0-2) was 46% at 90 days after the second procedure.
Repeated MT in short-term recurrent LVO is a rarity but appears to be safe and effective. The second thrombectomy should be pursued with the same extensive effort as the first procedure as these patients may achieve similar good outcomes.
关于颅内血管短期再闭塞患者重复机械取栓（MT）的频率和结果的数据有限。针对这一问题，我们报告了我们在 10 个三级护理中心进行的多中心经验，同时对文献进行了系统回顾。
对 2007 年 1 月至 2020 年 1 月期间，10 个三级护理中心连续收治的 30 天内接受 2 次 MT 治疗的急性脑卒中患者进行回顾性分析。记录患者的基线人口统计学、卒中病因、血管造影结果和 90 天改良 Rankin 量表（mRS）评估的临床转归。此外，还对因大血管闭塞（LVO）复发而重复 MT 的报告进行了系统回顾。
我们发现，在 7844 例患者中，有 30 例（0.4%）因 LVO 再发而在 30 天内接受了 2 次血栓切除术。通过系统回顾，符合纳入标准的 3 项研究中有 28 名参与者的 3 份报告符合条件。总共分析了 58 名患者：心源性栓塞事件分别是首次（65.5%）和第二次 LVO（60.3%）最常见的病因。首次 MT 前的中位数 NIHSS（国立卫生研究院卒中量表）为 13（IQR 8-16），第二次 MT 前为 15（IQR 11-19）（p=0.031）。首次 MT 后，91.4%的患者获得了成功再灌注，第二次 MT 后，86.2%的患者获得了成功再灌注（p=0.377）。第二次手术后 90 天，功能独立（mRS 0-2）的比例为 46%。
短期内 LVO 复发患者的重复 MT 较为罕见，但似乎是安全有效的。第二次取栓术应与第一次取栓术一样进行广泛的治疗，因为这些患者可能获得相似的良好转归。
