后循环串联闭塞：分类与技术。

Posterior circulation tandem occlusions: Classification and techniques.

机构信息

Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia 19107, PA USA.

Faculty of Medicine, American University of Beirut Medical Center, Beirut 00000, Lebanon.

出版信息

Clin Neurol Neurosurg. 2020 Nov;198:106154. doi: 10.1016/j.clineuro.2020.106154. Epub 2020 Aug 14.

DOI:10.1016/j.clineuro.2020.106154

PMID:32829201

Abstract

BACKGROUND

Posterior circulation tandem occlusions are poorly characterized in current literature. Data regarding endovascular approaches and outcomes in this patient subgroup is extremely limited.

METHODS

We conducted a retrospective analysis of a prospectively maintained database and identified 17 patients with posterior circulation tandem occlusions who underwent mechanical thrombectomy between 2014 and 2019.

RESULTS

Of 17 patients with posterior circulation tandem occlusion, the mean age was 55.76 ± 11.8 with 35.3% female. The mean NIHSS score on presentation was 17.2 ± 9.2. Tissue plasminogen activator was administered in 7 (41.2%) patients, stent-retrievers alone were used in 2 (11.8%), aspiration catheters alone were used in 2 (11.8%), a combination was used 12 (70.6%), and a self-expandable stent in 5 (29.4%). The mean number of device passes was 2.24 ± 2.02, recanalization failure occurred in 4 (23.5%) patients, the mean time from stroke onset to puncture was 6.9 ± 2.4 h, and the mean time from puncture to recanalization was 59.3 ± 26.6 min. Postprocedural symptomatic ICH occurred in 1 (5.9 %) patient, periprocedural ICH/SAH occurred in 2 (11.8%), periprocedural distal emboli occurred in 0 (0%), periprocedural vessel dissection occurred in 1 (5.9%), and periprocedural vessel perforation occurred in 1 (5.9%) patient. TICI score>2b was achieved in 13 (76.5%) patients. An improvement in NIHSS>3 at discharge occurred in 10 (58.8%) patients, and good outcomes (mRS score < 2) occurred in 7 (41.2%). The mean length of stay was 11.6 ± 12.2 days, and the mortality rate was 41.2%.

CONCLUSION

Endovascular intervention with mechanical thrombectomy is safe and feasible in patients with posterior circulation tandem occlusions.

摘要

背景

目前的文献中对后循环串联闭塞的描述甚少。关于该患者亚组的血管内治疗方法和结果的数据极为有限。

方法

我们对一个前瞻性维护的数据库进行了回顾性分析，并确定了 17 例在 2014 年至 2019 年间接受机械血栓切除术的后循环串联闭塞患者。

结果

17 例后循环串联闭塞患者中，平均年龄为 55.76±11.8 岁，女性占 35.3%。发病时 NIHSS 评分平均为 17.2±9.2。7 例（41.2%）患者给予组织型纤溶酶原激活剂，2 例（11.8%）单独使用支架取栓器，2 例（11.8%）单独使用抽吸导管，12 例（70.6%）联合使用，5 例（29.4%）使用自膨式支架。平均使用装置次数为 2.24±2.02 次，4 例（23.5%）患者再通失败，发病至穿刺时间平均为 6.9±2.4 h，穿刺至再通时间平均为 59.3±26.6 min。术后症状性 ICH 发生 1 例（5.9%），围手术期 ICH/SAH 发生 2 例（11.8%），围手术期远端栓塞发生 0 例（0%），围手术期血管夹层发生 1 例（5.9%），围手术期血管穿孔发生 1 例（5.9%）。13 例（76.5%）患者 TICI 评分>2b。出院时 NIHSS 评分改善>3 分 10 例（58.8%），预后良好（mRS 评分<2）7 例（41.2%）。平均住院时间为 11.6±12.2 天，死亡率为 41.2%。