Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany,
Department of Internal Medicine, Helios Hospital Siegburg, Siegburg, Germany.
Cerebrovasc Dis. 2020;49(3):277-284. doi: 10.1159/000508028. Epub 2020 Jun 16.
Stent retriever technology has evolved, and significantly longer devices have become available for mechanical thrombectomy (MT) of large cerebral vessel occlusions in ischemic stroke. We hypothesized that increased stent retriever length may improve the rate of complete angiographic reperfusion and decrease the respective number of attempts, resulting in a better clinical outcome.
Retrospective analysis of patients with large vessel occlusion in the anterior and posterior circulation treated with stent retriever MT. The study group was dichotomized into short (20 mm) and long (>20 mm) retrievers using propensity matching. In the anterior circulation, the clot burden score was evaluated. Primary end points were first-pass modified thrombolysis in cerebral infarction (mTICI) 3 reperfusion and first-pass mTICI ≥ 2b reperfusion, and the secondary end point was functional independence (defined as modified Rankin Scale score 0-2) at discharge and 90 days.
Overall, 394 patients were included in the analysis. In the anterior circulation, short stent retrievers had a significantly higher rate of first-pass reperfusion in cases with low clot burden (mTICI 3: 27% vs. 17%; p = 0.009; mTICI ≥ 2b: 42 vs. 30%; p = 0.005) and in middle cerebral artery occlusions (mTICI ≥ 2b: 51 vs. 41%; p = 0.024). Higher rates of favorable outcome at discharge and 90 days were observed for the short stent retriever group (p < 0.001).
Stent retriever length should be adjusted to clot burden score and vessel occlusion site.
支架取栓技术不断发展，用于治疗缺血性脑卒中的大血管闭塞的机械血栓切除术（MT）的支架取栓装置长度也显著增加。我们假设，增加支架取栓装置的长度可能会提高完全血管再通率，并减少相应的尝试次数，从而改善临床结局。
回顾性分析采用支架取栓 MT 治疗的前循环和后循环大血管闭塞患者。使用倾向评分匹配法将研究组分为短（20mm）和长（>20mm）取栓器。在前循环中，评估血栓负荷评分。主要终点是首次通过改良脑梗死溶栓（mTICI）3 级再通和首次通过 mTICI≥2b 级再通，次要终点是出院和 90 天时的功能独立性（定义为改良 Rankin 量表评分 0-2）。
总体而言，394 例患者纳入分析。在前循环中，低血栓负荷（mTICI 3 级：27% vs. 17%；p=0.009；mTICI≥2b 级：42% vs. 30%；p=0.005）和大脑中动脉闭塞（mTICI≥2b 级：51% vs. 41%；p=0.024）患者中，短支架取栓器的首次再通率显著更高。短支架取栓器组出院和 90 天时的良好结局发生率更高（p<0.001）。
支架取栓装置的长度应根据血栓负荷评分和血管闭塞部位进行调整。
