Szmygin Maciej, Sojka Michał, Pyra Krzysztof, Tarkowski Piotr, Luchowski Piotr, Wojczal Joanna, Drelich-Zbroja Anna, Jargiełło Tomasz
Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland.
Department of Diagnostic Radiology and Nuclear Medicine, Medical University of Lublin, Lublin, Poland.
Acta Radiol. 2021 Oct;62(10):1374-1380. doi: 10.1177/0284185120962735. Epub 2020 Oct 4.
Mechanical thrombectomy (MT) is well-established in the treatment of acute ischemic anterior circulation stroke. However, there is no evidence from randomized trials or meta-analyses that MT is safe and effective in the treatment of patients with acute ischemic posterior circulation stroke (PCS).
To evaluate the clinical and procedural factors associated with recanalization and outcome of patients with PCS treated with MT.
Forty-three patients with PCS (median age 73 years) who underwent treatment with MT were included. Data including demographics, baseline stroke severity, radiological imaging, procedure and post-procedure complications were documented. Clinical outcome was evaluated using the modified Rankin Scale (mRS). The patients were classified into two groups based on clinical outcome (favorable vs. unfavorable mRS after 90 days).
Median baseline National Institute of Health Stroke Scale (NIHSS) was 17. Twenty patients were eligible for intravenous thrombolysis and received recombinant tissue plasminogen activator before MT. Successful recanalization was observed in 88.4% of patients. After 90 days, favorable outcome (defined as mRS 0-2) was achieved in 26 patients; six patients had an unfavorable outcome (mRs >2). Final mortality rate was 25.5%. Baseline NIHSS, onset to reperfusion time, procedure duration, and successful recanalization had a statistically significant association with outcome. Failed recanalization and occurrence of intracranial hemorrhage were found to be associated with a higher mortality rate.
MT is feasible and effective method in treatment of PCS. Baseline NIHSS and onset to reperfusion time were found to be independent predictive factors of clinical outcome.
机械取栓术（MT）在急性缺血性前循环卒中的治疗中已得到广泛应用。然而，尚无随机试验或荟萃分析的证据表明MT在急性缺血性后循环卒中（PCS）患者的治疗中是安全有效的。
评估与接受MT治疗的PCS患者再通及预后相关的临床和手术因素。
纳入43例接受MT治疗的PCS患者（中位年龄73岁）。记录包括人口统计学、基线卒中严重程度、放射影像学、手术及术后并发症等数据。使用改良Rankin量表（mRS）评估临床结局。根据临床结局（90天后mRS良好与不良）将患者分为两组。
基线美国国立卫生研究院卒中量表（NIHSS）中位数为17。20例患者符合静脉溶栓条件，并在MT前接受了重组组织型纤溶酶原激活剂治疗。88.4%的患者实现了成功再通。90天后，26例患者获得良好结局（定义为mRS 0 - 2）；6例患者结局不良（mRs>2）。最终死亡率为25.5%。基线NIHSS、发病至再灌注时间、手术持续时间和成功再通与结局有统计学显著关联。发现再通失败和颅内出血的发生与较高的死亡率相关。
MT是治疗PCS的可行且有效的方法。基线NIHSS和发病至再灌注时间是临床结局的独立预测因素。
