Departments of Neurology, Hadassah-Hebrew University Medical Center, P.O. Box 12000, 91120, Jerusalem, Israel.
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Neuroradiology. 2020 Oct;62(10):1335-1340. doi: 10.1007/s00234-020-02469-x. Epub 2020 Jun 16.
Clot extraction is associated with favorable outcome in patients with large vessel occlusions (LVO) undergoing endovascular thrombectomy (EVT). However, whether revascularization becomes futile or harmful with an increasing number of passes remains unknown.
We performed a retrospective analysis of 271 consecutive patients with LVO who underwent stentriever-based EVT as the primary recanalization strategy. Primary outcomes including favorable recanalization, survival, and favorable functional outcomes were compared according to a dichotomized number of stentriever passes utilized with a cutoff of 4.
In the entire cohort, 234 (86%) patients reached favorable recanalization and 46 (17%) patients had ≥ 5 passes (range 5-40). Patients that had ≤ 4 passes had significantly higher rates of favorable recanalization and favorable outcomes and a trend towards lower mortality rates compared with those that had ≥ 5 stentriever passes (92% vs. 61%; p < 0.001, 52% vs. 30%; p = 0.009 and 12% vs. 22%, p = 0.098). Among patients that received ≥ 5 stentriever passes, 30% reached favorable outcomes. Patients who achieved recanalization after ≥ 5 passes had higher rates of favorable outcome in comparison with those who did not (p = 0.009). Among patients that had ≥ 5 stentriever passes favorable recanalization (OR 97.3, 95%CI 2.8-3399.3) and admission NIHSS (OR 0.77, 95%CI 0.60-0.99) remained independent predictors of favorable outcome, whereas the number of passes did not.
A substantial proportion of patients reach favorable outcomes even when ≥ 5 stentriever passes are performed. Treatment choices should be individualized based on personal preferences and expertise as well as on patient and clot-specific characteristics.
在接受血管内血栓切除术（EVT）的大血管闭塞（LVO）患者中，血栓抽吸与良好的结局相关。然而，随着抽吸取栓次数的增加，血管再通是否变得无效或有害尚不清楚。
我们对 271 例接受支架取栓器为主要再通策略的 LVO 患者进行了回顾性分析。根据使用的支架取栓器次数分为两组（分界点为 4 次），比较两组患者的主要转归，包括良好的再通、生存率和良好的功能结局。
在整个队列中，234 例（86%）患者达到了良好的再通，46 例（17%）患者的抽吸取栓次数≥5 次（范围 5-40 次）。与抽吸取栓次数≥5 次的患者相比，抽吸取栓次数≤4 次的患者具有更高的良好再通率和良好结局率，且死亡率较低（92% vs. 61%，p＜0.001；52% vs. 30%，p=0.009；12% vs. 22%，p=0.098）。在接受≥5 次抽吸取栓的患者中，有 30%达到了良好结局。与未达到良好再通的患者相比，达到良好再通的患者在≥5 次抽吸取栓后获得良好结局的比例更高（p=0.009）。在≥5 次抽吸取栓的患者中，良好的再通（OR 97.3，95%CI 2.8-3399.3）和入院 NIHSS 评分（OR 0.77，95%CI 0.60-0.99）仍然是良好结局的独立预测因素，而抽吸取栓次数则不是。
即使进行了≥5 次抽吸取栓，仍有相当一部分患者获得了良好的结局。治疗选择应根据个人偏好和专业知识以及患者和血栓的特点进行个体化。
