单中心急性缺血性脑卒中患者的重复血管内血栓切除术。
Repeated Endovascular Thrombectomy in Patients with Acute Ischemic Stroke in a Single Center.
机构信息
Jeonbuk National University Medical School, Republic of Korea.
Department of Radiology and Research Institute of Clinical Medicine, Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, 567 Baekje-daero, deokjin-gu, Jeonju-si, Jeollabuk-do 561-756, Republic of Korea.
出版信息
J Stroke Cerebrovasc Dis. 2021 Jan;30(1):105457. doi: 10.1016/j.jstrokecerebrovasdis.2020.105457. Epub 2020 Nov 11.
BACKGROUND
Patients with acute ischemic stroke treated with endovascular thrombectomy may be treated with repeat endovascular thrombectomy (rEVT) in case of recurrent large vessel occlusion (LVO). The purpose of this study is to report the frequency, timing, and outcomes of rEVT in a single center.
MATERIALS AND METHODS
We retrospectively reviewed our databases for anterior or posterior circulation rEVT cases. Patient characteristics, procedural data, and functional outcomes (modified Rankin scale at 90 days) were analyzed. Early and late recurrence of stroke was divided at 30 days.
RESULTS
Of 1025 patients treated between January 2011 and January 2020, 23 (2.2%) underwent rEVT. The median time between the first and second procedure was 185 days; 7 (30.4%) patients were re-treated within 30 days. Eleven patients (47.8%) had different occlusion sites between the two procedures. Good clinical outcome of patients with late ipsilateral recurrence was significantly higher than that of patients with late contralateral recurrence (83.3% vs. 16.7, p = 0.027). Overall good functional outcome after the second procedure was 43.5% (10/23). Overall good functional outcome of early and late recurrence groups were similar (57.1% vs. 37.5%, p = 0.650). One patient died due to an underlying cardiac problem.
CONCLUSION
rEVT can be performed in patients with recurrent stroke of LVO. Ipsilateral recurrence of stroke was associated with good clinical outcome after rEVT.
背景
接受血管内血栓切除术治疗的急性缺血性脑卒中患者，如果再次出现大血管闭塞（LVO），可能需要进行重复血管内血栓切除术（rEVT）。本研究的目的是报告单一中心 rEVT 的频率、时间和结果。
材料和方法
我们回顾性地分析了我们的数据库中前循环或后循环 rEVT 病例。分析了患者特征、手术数据和功能结局（90 天改良 Rankin 量表）。将早期和晚期卒中复发分为 30 天。
结果
在 2011 年 1 月至 2020 年 1 月期间，1025 例患者中，23 例（2.2%）接受了 rEVT。首次和第二次手术之间的中位时间为 185 天；7 例（30.4%）患者在 30 天内再次治疗。11 例（47.8%）患者两次手术之间的闭塞部位不同。同侧晚期复发患者的良好临床结局明显高于对侧晚期复发患者（83.3% vs. 16.7%，p=0.027）。第二次手术后整体良好的功能结局为 43.5%（10/23）。早期和晚期复发组的整体良好功能结局相似（57.1% vs. 37.5%，p=0.650）。1 例患者因潜在心脏问题死亡。
结论
在 LVO 复发性卒中患者中可进行 rEVT。卒中同侧复发与 rEVT 后良好的临床结局相关。
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