Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea.
Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
J Neurointerv Surg. 2021 Apr;13(4):318-323. doi: 10.1136/neurintsurg-2020-016144. Epub 2020 Jun 25.
The optimal first-line mechanical thrombectomy (MT) method in cancer-related stroke (CRS) patients with emergent large vessel occlusion (ELVO) remains largely unknown. The aim of this study is to evaluate the efficacy and safety between contact aspiration (CA) first-line thrombectomy and stent retriever (SR) first-line thrombectomy in CRS patients.
Sixty-two CRS patients with ELVO, who underwent MT between January 2013 and October 2019 at our institution, were retrospectively analyzed. Patients were divided into two groups based on the first-line MT method and compared: the CA group (n=28), which included those who received CA alone or combined CA with SR, and the SR group (n=34), which included those who received conventional SR alone.
Overall, reperfusion was successful in 75.8% (47/62) of CRS patients, and a good clinical outcome at 90 days was observed in 17.7%. The CA group showed a higher rate of successful reperfusion (89.3% vs 64.7%, P=0.025) shorter procedure time (22 vs 42 min; P=0.029), higher rate of first pass effect (35.7% vs 11.8%, P=0.025), and lower number of passes (1 vs 3, P=0.023) when compared with the SR group. The procedural and hemorrhagic complication rates were similar between the CA and SR groups. The first-line contact aspiration (OR 11.624, 95% CI 1.041 to 129.752; P=0.046) was an independent predictor of successful reperfusion.
Among patients with CRS, CA - whether alone or in combination with SR - as first-line MT seems to provide more rapid and successful reperfusion when compared with SR.
在伴有紧急大血管闭塞（ELVO）的癌症相关性卒中（CRS）患者中，最佳的一线机械取栓（MT）方法仍知之甚少。本研究旨在评估接触抽吸（CA）一线血栓切除术与支架取栓器（SR）一线血栓切除术在 CRS 患者中的疗效和安全性。
回顾性分析了 2013 年 1 月至 2019 年 10 月期间在我院接受 MT 的 62 例 CRS 合并 ELVO 患者。根据一线 MT 方法将患者分为两组进行比较：CA 组（n=28），包括单独接受 CA 或 CA 联合 SR 的患者；SR 组（n=34），包括单独接受常规 SR 的患者。
总体而言，62 例 CRS 患者中有 75.8%（47/62）实现了再灌注，90 天临床预后良好的比例为 17.7%。CA 组再灌注成功率更高（89.3%比 64.7%，P=0.025），手术时间更短（22 分钟比 42 分钟；P=0.029），初次通过效应更高（35.7%比 11.8%，P=0.025），通过次数更少（1 次比 3 次，P=0.023）。CA 组与 SR 组的手术和出血并发症发生率相似。一线接触抽吸（OR 11.624，95%CI 1.041 至 129.752；P=0.046）是再灌注成功的独立预测因素。
在 CRS 患者中，CA-无论是单独使用还是与 SR 联合使用-作为一线 MT 似乎比 SR 提供更快速和更成功的再灌注。
