在机械血栓切除术中快速取栓可改善负易损血管征患者的再通率。
Fast Stent Retrieval during Mechanical Thrombectomy Improves Recanalization in Patients with the Negative Susceptibility Vessel Sign.
机构信息
From the Unité Mixte de recherche-S U1237 (S.S., M.Z., E.T.), Institut National de la Santé et de la Recherche Médicale, Normandie University , Université Caen-Normandie, Cyceron, Caen, France
Department of Neuroradiology (S.S., J.-B.E., S.C.-R., P.-F.M., C.G., M.S., M.G., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Université de Champagne-Ardenne, Reims, France.
出版信息
AJNR Am J Neuroradiol. 2021 Apr;42(4):726-731. doi: 10.3174/ajnr.A6989. Epub 2021 Feb 11.
BACKGROUND AND PURPOSE
In acute ischemic stroke, the negative susceptibility vessel sign on T2*-weighted images traditionally highlights fibrin-rich clots, which are particularly challenging to remove. In vitro, fast stent retrieval improves fibrin-rich clot extraction. We aimed to evaluate whether the speed of stent retrieval influences the recanalization and clinical outcome of patients presenting with the negative susceptibility vessel sign.
MATERIALS AND METHODS
Patients were identified from a registry of patients with ischemic stroke receiving mechanical thrombectomy between January 2016 and January 2020. Inclusion criteria were the following: 1) acute ischemic stroke caused by an isolated occlusion of the anterior circulation involving the MCA (Internal Carotid Artery-L, M1, M2) within 8 hours of symptom onset; 2) a negative susceptibility vessel sign on prethrombectomy T2*-weighted images; and 3) treatment with a combined technique (stent retriever + contact aspiration). Patients were dichotomized according to retrieval speed (fast versus slow). The primary outcome was the first-pass recanalization rate.
RESULTS
Of 68 patients who met inclusion criteria, 31 (45.6%) were treated with fast retrieval. Patients receiving a fast retrieval had greater odds of first-pass complete (relative risk and 95% confidence interval [RR 95% CI], 4.30 [1.80-10.24]), near-complete (RR 95% CI, 3.24 [1.57-6.68]), and successful (RR 95% CI, 2.60 [1.53-4.43]) recanalization as well as greater odds of final complete (RR 95% CI, 4.18 [1.93-9.04]), near-complete (RR 95% CI, 2.75 [1.55-4.85]), and successful (RR 95% CI, 1.52 [1.14-2.03]) recanalization. No significant statistical differences in procedure-related serious adverse events, distal embolization, or symptomatic intracranial hemorrhage were reported. No differences were noted in terms of functional independence (RR 95% CI, 1.01 [0.53-1.93]) and all-cause mortality (RR 95% CI, 0.90 [0.35-2.30]) at 90 days.
CONCLUSIONS
A fast stent retrieval during mechanical thrombectomy is safe and improves the retrieval of clots with the negative susceptibility vessel sign.
背景与目的
在急性缺血性脑卒中中，T2*-加权图像上的负性血管征传统上突出富含纤维蛋白的血栓，这些血栓尤其难以清除。在体外，快速支架取栓可提高富含纤维蛋白的血栓提取效率。本研究旨在评估支架取栓速度是否会影响伴有负性血管征的患者的再通和临床结局。
材料与方法
本研究从 2016 年 1 月至 2020 年 1 月接受机械取栓治疗的缺血性脑卒中患者登记中筛选出符合条件的患者。纳入标准为：1）由前循环孤立性闭塞引起的急性缺血性脑卒中，MCA（颈内动脉颅内段-L、M1、M2）受累，症状发作后 8 小时内；2）术前 T2*-加权图像上存在负性血管征；3）采用联合技术（支架取栓+接触抽吸）治疗。根据取栓速度（快速与缓慢）将患者分为两组。主要结局为首次通过再通率。
结果
在符合纳入标准的 68 例患者中，31 例（45.6%）接受了快速取栓。与缓慢取栓相比，快速取栓患者更有可能实现首次通过完全（比值比和 95%置信区间 [OR 95% CI]，4.30 [1.80-10.24]）、接近完全（OR 95% CI，3.24 [1.57-6.68]）和成功（OR 95% CI，2.60 [1.53-4.43]）再通，且更有可能实现最终完全（OR 95% CI，4.18 [1.93-9.04]）、接近完全（OR 95% CI，2.75 [1.55-4.85]）和成功（OR 95% CI，1.52 [1.14-2.03]）再通。两组在与操作相关的严重不良事件、远端栓塞或症状性颅内出血方面无显著统计学差异。90 天的功能独立性（OR 95% CI，1.01 [0.53-1.93]）和全因死亡率（OR 95% CI，0.90 [0.35-2.30]）无差异。
结论
机械取栓过程中快速支架取栓安全，可提高伴有负性血管征的血栓的取出效率。
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