Mohamed Ghada A, Aboul Nour Hassan, Nogueira Raul G, Mohammaden Mahmoud H, Haussen Diogo C, Al-Bayati Alhamza R, Nguyen Thanh N, Abdalkader Mohamad, Kaliaev Artem, Ma Alice, Fifi Johanna, Morey Jacob, Yavagal Dileep R, Saini Vasu, Ortega-Gutierrez Santiago, Farooqui Mudassir, Zevallos Cynthia B, Quispe-Orozco Darko, Schultz Lonni, Kole Maximilian, Miller Daniel, Mayer Stephan A, Marin Horia, Bou Chebl Alex
Department of Neurology, Henry Ford Hospital, Detroit, MI (G.A.M., H.A.N., L.S., D.M., A.B.C.).
Department of Neurology and interventional radiology, Emory University Hospitals, Atlanta, GA (R.G.N., M.H.M., D.C.H., A.R.A.-B.).
Stroke. 2021 Jun;52(6):1967-1973. doi: 10.1161/STROKEAHA.120.033393. Epub 2021 Apr 29.
Mechanical thrombectomy (MT) is now the standard of care for large vessel occlusion (LVO) stroke. However, little is known about the frequency and outcomes of repeat MT (rMT) for patients with recurrent LVO.
This is a retrospective multicenter cohort of patients who underwent rMT at 6 tertiary institutions in the United States between March 2016 and March 2020. Procedural, imaging, and outcome data were evaluated. Outcome at discharge was evaluated using the modified Rankin Scale.
Of 3059 patients treated with MT during the study period, 56 (1.8%) underwent at least 1 rMT. Fifty-four (96%) patients were analyzed; median age was 64 years. The median time interval between index MT and rMT was 2 days; 35 of 54 patients (65%) experienced recurrent LVO during the index hospitalization. The mechanism of stroke was cardioembolism in 30 patients (56%), intracranial atherosclerosis in 4 patients (7%), extracranial atherosclerosis in 2 patients (4%), and other causes in 18 patients (33%). A final TICI recanalization score of 2b or 3 was achieved in all 54 patients during index MT (100%) and in 51 of 54 patients (94%) during rMT. Thirty-two of 54 patients (59%) experienced recurrent LVO of a previously treated artery, mostly the pretreated left MCA (23 patients, 73%). Fifty of the 54 patients (93%) had a documented discharge modified Rankin Scale after rMT: 15 (30%) had minimal or no disability (modified Rankin Scale score ≤2), 25 (50%) had moderate to severe disability (modified Rankin Scale score 3-5), and 10 (20%) died.
Almost 2% of patients treated with MT experience recurrent LVO, usually of a previously treated artery during the same hospitalization. Repeat MT seems to be safe and effective for attaining vessel recanalization, and good outcome can be expected in 30% of patients.
机械取栓术（MT）目前是大血管闭塞（LVO）性卒中的标准治疗方法。然而，对于复发性LVO患者进行重复MT（rMT）的频率和结局知之甚少。
这是一项回顾性多中心队列研究，研究对象为2016年3月至2020年3月期间在美国6家三级医疗机构接受rMT的患者。对手术、影像学和结局数据进行了评估。出院时的结局采用改良Rankin量表进行评估。
在研究期间接受MT治疗的3059例患者中，56例（1.8%）接受了至少1次rMT。对54例（96%）患者进行了分析；中位年龄为64岁。首次MT与rMT之间的中位时间间隔为2天；54例患者中有35例（65%）在首次住院期间发生复发性LVO。卒中机制为心源性栓塞的有30例（56%），颅内动脉粥样硬化的有4例（7%），颅外动脉粥样硬化的有2例（4%），其他原因的有18例（33%）。所有54例患者在首次MT期间均实现了最终的脑梗死溶栓分级（TICI）再通评分2b或3（100%），在rMT期间54例患者中有51例（94%）实现了该评分。54例患者中有32例（59%）发生了先前治疗动脉的复发性LVO，主要是先前治疗的左侧大脑中动脉（23例，73%）。54例患者中有50例（93%）在rMT后有记录的出院改良Rankin量表评分：15例（30%）有轻度或无残疾（改良Rankin量表评分≤2），25例（50%）有中度至重度残疾（改良Rankin量表评分3 - 5），10例（20%）死亡。
接受MT治疗的患者中近2%发生复发性LVO，通常在同一住院期间发生在先前治疗的动脉。重复MT在实现血管再通方面似乎是安全有效的，30%的患者有望获得良好结局。
