Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.
Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.
Neurosurgery. 2020 Oct 15;87(5):982-991. doi: 10.1093/neuros/nyaa179.
Randomized controlled trials evaluating mechanical thrombectomy (MT) for acute ischemic stroke predominantly studied anterior circulation patients. Both procedural and clinical predictors of outcome in posterior circulation patients have not been evaluated in large cohort studies.
To investigate technical and clinical predictors of functional independence after posterior circulation MT while comparing different frontline thrombectomy techniques.
In a retrospective multicenter international study of 3045 patients undergoing MT for stroke between 06/2014 and 12/2018, 345 patients had posterior circulation strokes. MT was performed using aspiration, stent retriever, or combined approach. Functional outcomes were assessed using the 90-d modified Rankin score dichotomized into good (0-2) and poor outcomes (3-6).
We included 2700 patients with anterior circulation and 345 patients with posterior circulation strokes. Posterior patients (age: 60 ± 14, 46% females) presented with mainly basilar occlusion (80%) and were treated using contact aspiration or ADAPT (39%), stent retriever (31%) or combined approach (19%). Compared to anterior strokes, posterior strokes had delayed treatment (500 vs 340 min, P < .001), higher national institute of health stroke scale (NIHSS) (17.1 vs 15.7, P < .01) and lower rates of good outcomes (31% vs 43%, P < .01). In posterior MT, diabetes (OR = 0.28, 95%CI: 0.12-0.65), admission NIHSS (OR = 0.9, 95%CI: 0.86-0.94), and use of stent retriever (OR = 0.26, 95%CI: 0.11-0.62) or combined approach (OR = 0.35, 95%CI: 0.12-1.01) vs ADAPT were associated with lower odds of good outcome. Stent retriever use was associated with lower odds of good outcomes compared to ADAPT even when including patients with only basilar occlusion or with successful recanalization only.
Despite similar safety profiles, use of ADAPT is associated with higher rates of functional independence after posterior circulation thrombectomy compared to stent retriever or combined approach in large "real-world" retrospective study.
评估机械取栓（MT）治疗急性缺血性脑卒中的随机对照试验主要研究了前循环患者。在大型队列研究中，尚未评估后循环患者的手术和临床预后预测因素。
研究后循环 MT 后功能独立的技术和临床预测因素，同时比较不同的一线取栓技术。
在一项回顾性多中心国际研究中，对 2014 年 6 月至 2018 年 12 月期间接受 MT 治疗的 3045 例脑卒中患者进行分析，其中 345 例为后循环脑卒中患者。MT 采用抽吸、支架取栓或联合方法进行。使用 90 天改良 Rankin 量表将功能结局分为良好（0-2 分）和不良结局（3-6 分）进行评估。
我们纳入了 2700 例前循环和 345 例后循环脑卒中患者。后循环患者（年龄：60±14 岁，46%为女性）主要为基底动脉闭塞（80%），采用接触抽吸或 ADAPT（39%）、支架取栓（31%）或联合方法（19%）治疗。与前循环脑卒中相比，后循环脑卒中的治疗时间较晚（500 分钟 vs 340 分钟，P <.001），国立卫生研究院卒中量表（NIHSS）评分较高（17.1 分 vs 15.7 分，P <.01），良好结局的比例较低（31% vs 43%，P <.01）。在后循环 MT 中，糖尿病（OR=0.28，95%CI：0.12-0.65）、入院 NIHSS（OR=0.9，95%CI：0.86-0.94）、支架取栓（OR=0.26，95%CI：0.11-0.62）或联合方法（OR=0.35，95%CI：0.12-1.01）的使用与良好结局的可能性降低相关。与 ADAPT 相比，支架取栓的使用与良好结局的可能性降低相关，即使包括仅基底动脉闭塞或仅再通的患者。
在这项大型“真实世界”回顾性研究中，尽管安全性相似，但与支架取栓或联合方法相比，在后循环取栓中使用 ADAPT 与更高的功能独立性率相关。
