Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
J Neurointerv Surg. 2021 Jul;13(7):599-604. doi: 10.1136/neurintsurg-2020-016005. Epub 2020 Jul 31.
The first-pass effect (FPE) has emerged as a key metric for efficacy in mechanical thrombectomy (MT). The hyperdense vessel sign (HDVS) on non-contrast head CT (NCCT) indicates a higher clot content of red blood cells.
To assess whether the HDVS could serve as an imaging biomarker for guiding first-line device selection in MT.
A prospective MT database was reviewed for consecutive patients with anterior circulation large vessel occlusion stroke who underwent thrombectomy with stent retriever (SR) or contact aspiration (CA) as first-line therapy between January 2012 and November 2018. Pretreatment NCCT scans were evaluated for the presence of HDVS. The primary outcome was FPE (modified Thrombolysis in Cerebral Infarction score 2c/3). The primary analysis was the interaction between HDVS and thrombectomy modality on FPE. Secondary analyses aimed to evaluate the predictors of FPE.
A total of 779 patients qualified for the analysis. HDVS and FPE were reported in 473 (60.7%) and 286 (36.7%) patients, respectively. The presence of HDVS significantly modified the effect of thrombectomy modality on FPE (p=0.01), with patients with HDVS having a significantly higher rate of FPE with a SR (41.3% vs 22.2%, p=0.001; adjusted OR 2.11 (95% CI 1.20 to 3.70), p=0.009) and non-HDVS patients having a numerically better response to CA (41.4% vs 33.9%, p=0.28; adjusted OR 0.58 (95% CI 0.311 to 1.084), p=0.088). Age (OR 1.01 (95% CI 1.00 to 1.02), p=0.04) and balloon guide catheter (OR 2.08 (95% CI 1.24 to 3.47), p=0.005) were independent predictors of FPE in the overall population.
Our data suggest that patients with HDVS may have a better response to SRs than CA for the FPE. Larger confirmatory prospective studies are warranted.
首次通过效应（FPE）已成为机械血栓切除术（MT）疗效的关键指标。非对比头部 CT（NCCT）上的高密度血管征（HDVS）表示红细胞的血栓含量更高。
评估 HDVS 是否可以作为 MT 中指导一线设备选择的影像学生物标志物。
回顾性分析 2012 年 1 月至 2018 年 11 月期间接受支架取栓（SR）或接触抽吸（CA）作为一线治疗的前循环大血管闭塞性卒中连续患者的前瞻性 MT 数据库。评估预处理 NCCT 扫描是否存在 HDVS。主要结局是 FPE（改良脑梗死溶栓评分 2c/3）。主要分析是 HDVS 与血栓切除术方式对 FPE 的相互作用。次要分析旨在评估 FPE 的预测因素。
共有 779 名患者符合分析条件。473 名（60.7%）和 286 名（36.7%）患者分别报告了 HDVS 和 FPE。HDVS 的存在显著改变了血栓切除术方式对 FPE 的影响（p=0.01），HDVS 患者 SR 的 FPE 发生率明显更高（41.3%比 22.2%，p=0.001；调整 OR 2.11（95%CI 1.20 至 3.70），p=0.009），而非 HDVS 患者对 CA 的反应更好（41.4%比 33.9%，p=0.28；调整 OR 0.58（95%CI 0.311 至 1.084），p=0.088）。年龄（OR 1.01（95%CI 1.00 至 1.02），p=0.04）和球囊导引导管（OR 2.08（95%CI 1.24 至 3.47），p=0.005）是总体人群中 FPE 的独立预测因素。
我们的数据表明，HDVS 患者的 FPE 可能对 SR 的反应优于 CA。需要更大的前瞻性确认研究。
