Neuroradiology Department, 159003Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
Interv Neuroradiol. 2021 Jun;27(3):419-426. doi: 10.1177/1591019920974183. Epub 2020 Nov 20.
Longer intervals to reperfusion in patients treated with mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO) stroke are associated with worse outcomes and influenced by the operator's ability to navigate individual anatomy. Our aims were to assess the impact of time from puncture to first deployment of the MT device (DT) on technical and clinical outcomes, develop an natomical Asessment for echanical hrombectomy core (ASMETS) that could predict DT and assess how different methods of intracranial access (coaxial-direct or exchange) influence this.
Retrospective review of a prospective database of patients treated with MT for ELVO between November 2015 and August 2018. CTAs were assessed for ASMETS. Intracranial access technique was at the discretion of the operator. Technical and clinical outcomes and complications were recorded. Linear and logistic regression analysis was performed.
92 patients were included. The impact of DT on clinical outcomes was significant. An unfavourable ASMET score is significantly associated with longer DT (p = 0.002) and linear regression showed DT time can be predicted by ASMETS - F(1,90) = 6.182, p = 0.015. No difference was demonstrated between different access techniques.
CTA-based ASMETS can predict time between arterial puncture and deployment of the mechanical thrombectomy device in stroke patients, irrespective of the technique used to catheterise the target ICA. This could inform the operator in preparing appropriate strategies to overcome challenging vascular anatomy in patients undergoing MT.
接受机械血栓切除术（MT）治疗紧急大血管闭塞（ELVO）卒中的患者，再灌注时间间隔延长与预后较差相关，并受术者个体血管解剖结构处理能力的影响。我们的目的是评估从穿刺到首次部署 MT 装置（DT）的时间对技术和临床结局的影响，开发一种能够预测 DT 的解剖评估机械血栓切除术核心（ASMETS），并评估不同的颅内入路（同轴-直接或交换）方法如何影响这一点。
回顾性分析 2015 年 11 月至 2018 年 8 月期间接受 MT 治疗 ELVO 的前瞻性数据库中的患者。对 CTAs 进行 ASMETS 评估。颅内入路技术由术者决定。记录技术和临床结局及并发症。进行线性和逻辑回归分析。
共纳入 92 例患者。DT 对临床结局的影响显著。不良 ASMET 评分与较长的 DT 显著相关（p=0.002），线性回归显示 DT 时间可由 ASMETS 预测 - F(1,90)=6.182，p=0.015。不同入路技术之间无差异。
基于 CTA 的 ASMETS 可预测卒中患者动脉穿刺与部署机械血栓切除术装置之间的时间，与用于导管插入目标 ICA 的技术无关。这可以为术者提供信息，以便为接受 MT 的患者制定适当的策略来克服具有挑战性的血管解剖结构。
