Institute of Diagnostic and Interventional Neuroradiology (J.K., E.P., J.G.), Inselspital, University Hospital Bern, University of Bern, Switzerland.
Institute of Diagnostic, Interventional and Pediatric Radiology (J.K.), Inselspital, University Hospital Bern, University of Bern, Switzerland.
Stroke. 2020 Sep;51(9):e232-e237. doi: 10.1161/STROKEAHA.120.029629. Epub 2020 Jul 13.
Acute ischemic stroke caused by primary multivessel occlusions (pMVO) is a rare but devastating disease. Whether multi-target mechanical thrombectomy for pMVO is beneficial remains unknown.
Multicenter retrospective review of patients treated with multi-target mechanical thrombectomy. The following pMVO sites were included: basilar artery, internal carotid artery, and middle cerebral artery (M1 and M2). Baseline characteristics were reported together with interventional technique, technical efficacy, and safety parameters. Clinical outcomes were evaluated applying the National Institutes of Health Stroke Scale and modified Rankin Scale. A systematic literature review was performed to summarize previous reports on pMVO mechanical thrombectomy.
Of 6081 patients screened, 21 patients met the inclusion criteria (0.35% [95% CI, 0.23%-0.53%]). In 70% (14/20) a cardioembolic cause was reported. A successful reperfusion of Thrombolysis in Cerebral Infarction scale score ≥2b was achieved in 95.2% (20/21) for the first and 76.1% (16/21) for the second target vessel. In those who survived the acute hospital stay (n=10/21), median admission National Institutes of Health Stroke Scale improved from 21 (interquartile range, 13-27) to 8 (interquartile range, 2-20) at discharge (=0.006). Mortality was 60% (12/20) at 90 days and only 20% (4/20) of patients reached modified Rankin Scale score ≤2. Acceptable outcomes were almost exclusively observed in pMVO patients presenting with at least one M2 occlusion.
Multi-target mechanical thrombectomy for pMVOs is rarely performed; however, the procedure appears to be feasible and safe with high reperfusion rates for both occlusion sites. More than half of all treated patients deceased early and favorable outcomes may only be expected for pMVO patients including at least one M2 occlusion.
由原发性多血管闭塞（pMVO）引起的急性缺血性脑卒中是一种罕见但具有破坏性的疾病。对于 pMVO 是否进行多靶点机械取栓治疗仍不清楚。
对接受多靶点机械取栓治疗的患者进行多中心回顾性分析。纳入的 pMVO 部位包括基底动脉、颈内动脉和大脑中动脉（M1 和 M2）。报告了基线特征以及介入技术、技术效果和安全性参数。采用国立卫生研究院卒中量表（NIHSS）和改良 Rankin 量表（mRS）评估临床转归。对以往关于 pMVO 机械取栓的文献进行了系统综述。
在筛选的 6081 例患者中，21 例符合纳入标准（0.35%[95%CI，0.23%-0.53%]）。70%（14/20）的患者报告有心源性栓塞病因。20 例患者中，21 例（95.2%）首次、16 例（76.1%）第二次目标血管达到溶栓治疗脑梗死（TICI）分级≥2b 级再通。在急性住院期间存活的患者（n=10/21）中，中位数入院 NIHSS 评分从 21 分（四分位距，13-27）下降至出院时的 8 分（四分位距，2-20）（=0.006）。90 天死亡率为 60%（12/20），仅有 20%（4/20）的患者 mRS 评分≤2。可接受的转归几乎仅见于至少有一处 M2 闭塞的 pMVO 患者。
多靶点机械取栓治疗 pMVOs 很少进行；然而，该方法对于两个闭塞部位的再通率较高，具有较高的可行性和安全性。接受治疗的患者中超过一半早期死亡，只有至少包括一处 M2 闭塞的 pMVO 患者可能获得良好的预后。
