大脑中动脉M2段闭塞所致急性缺血性卒中采用支架取栓器与抽吸术的血栓切除术结果：一项多中心经验
Thrombectomy Outcomes in Acute Ischemic Stroke due to Middle Cerebral Artery M2 Occlusion with Stent Retriever versus Aspiration: A Multicenter Experience.
作者信息
Atchaneeyasakul Kunakorn, Malik Amer M, Yavagal Dileep R, Haussen Diogo C, Jadhav Ashutosh P, Bouslama Mehdi, Kenmuir Cynthia L, Desai Shashvat, Grossberg Jonathan A, Chaturvedi Seemant, Jovin Tudor G, Nogueira Raul G
机构信息
Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA.
Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
出版信息
Interv Neurol. 2020 Jan;8(2-6):180-186. doi: 10.1159/000500198. Epub 2019 Jun 18.
OBJECTIVE
To examine outcomes for thrombectomy devices used for treatment of acute ischemic stroke (AIS) with middle cerebral artery (MCA) M2 segment emergent large vessel occlusion (ELVO) as the optimal device for such reperfusion is not clearly defined.
METHODS
A retrospective cohort study of consecutive AIS patients with MCA M2 ELVO undergoing thrombectomy from 3 academic medical centers was conducted from October 1999 through June 2016. The patients were divided based on the device utilized. Multivariate analysis of associations between devices (stent retriever or aspiration only [manual or pump aspiration system]) was performed. Primary outcomes were good recanalization (i.e., modified thrombolysis in cerebral infarction score ≥2b) and a favorable modified Rankin scale (mRS) score (i.e. ≤2). The secondary outcome was symptomatic intracerebral hemorrhage (sICH).
RESULTS
A total of 197 AIS patients underwent MCA M2 ELVO thrombectomy with either a stent retriever ( = 120) or aspiration only ( = 77). The aspiration-only group utilized either manual ( = 38) or pump aspiration ( = 39). Utilization of a stent retriever over manual aspiration is independently associated with higher odds of a favorable mRS score (OR = 3.2; 95% CI 1.02-9.7) and lower odds of sICH (OR = 0.09; 95% CI 0.03-0.31). Utilization of a stent retriever over a pump aspiration system is independently associated with higher odds of good recanalization (OR = 3.8; 95% CI 1.5-9.6). Utilization of a newer-generation pump aspiration catheter compared to a stent retriever resulted in similar rates of favorable mRS scores, sICH, successful recanalization, and mortality.
CONCLUSION
Utilization of a newer-generation pump aspiration catheter compared to a stent retriever resulted in similar outcomes, but worse outcomes were seen with the manual aspiration technique. These findings need to be confirmed with a large randomized trial utilizing stent retrievers and newer-generation pump aspiration systems.
目的
探讨用于治疗急性缺血性卒中（AIS）合并大脑中动脉（MCA）M2段急性大血管闭塞（ELVO）的取栓装置的疗效，因为目前尚未明确哪种装置是此类再灌注的最佳选择。
方法
对1999年10月至2016年6月期间在3家学术医疗中心接受取栓治疗的连续AIS合并MCA M2 ELVO患者进行回顾性队列研究。根据所使用的装置对患者进行分组。对装置（支架取栓器或仅采用抽吸[手动或泵吸系统]）之间的关联进行多变量分析。主要结局为良好再通（即脑梗死改良溶栓评分≥2b）和改良Rankin量表（mRS）评分良好（即≤2）。次要结局为症状性颅内出血（sICH）。
结果
共有197例AIS合并MCA M2 ELVO患者接受了取栓治疗，其中使用支架取栓器的有120例，仅采用抽吸的有77例。仅采用抽吸组中，38例采用手动抽吸，39例采用泵吸。与手动抽吸相比，使用支架取栓器与mRS评分良好的较高几率独立相关（OR = 3.2；95% CI 1.02 - 9.7），与sICH的较低几率独立相关（OR = 0.09；95% CI 0.03 - 0.31）。与泵吸系统相比，使用支架取栓器与良好再通的较高几率独立相关（OR = 3.8；95% CI 1.5 - 9.6）。与支架取栓器相比，使用新一代泵吸导管导致mRS评分良好、sICH、成功再通和死亡率的发生率相似。
结论
与支架取栓器相比，使用新一代泵吸导管导致的结局相似，但手动抽吸技术的结局较差。这些发现需要通过一项使用支架取栓器和新一代泵吸系统的大型随机试验来证实。
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