Department of Radiology, Busan Regional Cardio-Cerebrovascular Disease Center, Dong-A University Hospital, Busan, Republic of Korea.
Department of Neurosurgery, Busan Regional Cardio-Cerebrovascular Disease Center, Dong-A University Hospital, Busan, Republic of Korea.
PLoS One. 2021 Jun 10;16(6):e0252641. doi: 10.1371/journal.pone.0252641. eCollection 2021.
Mechanical thrombectomy using the stent-retriever in conjunction with the distal access catheter may improve the rates of successful revascularization and clinical outcomes in patients with acute stroke. We aimed to compare two different thrombectomy techniques, according to the position of the distal access catheter tip in the combined stent-retriever and aspiration approach.
In this retrospective study, patients with middle cerebral artery occlusion treated with the combined technique were divided into two groups based on the tip position of the distal access catheter: distal group (catheter placed adjacent to the thrombus) and proximal group (catheter placed in the cavernous segment of the internal carotid artery below the ophthalmic artery). Baseline characteristics, angiographic results, and clinical outcomes were compared.
Eighty-three patients (distal group, n = 45; proximal group, n = 38) were included. Higher complete reperfusion was observed in the distal group (unweighted analysis: 66.7% vs. 42.1%, p = 0.025; weighted analysis: 74.0% vs. 28.8%; p = 0.002). In the multivariate analysis, the distal tip position was independently associated with complete reperfusion (unweighted analysis: aOR, 4.10; 95% CI, 1.40-11.98; p = 0.01; weighted analysis: aOR, 5.20; 95% CI, 1.72-15.78; p = 0.004). The distal group also showed more favorable clinical outcomes and early neurological improvement (unweighted analysis: 62.2% vs. 55.3%; p = 0.521, 60% vs. 50%; p = 0.361, respectively; weighted analysis: 62.7% vs. 61.1%; p = 0.877, 66% vs. 45.7%; p = 0.062, respectively). However, more arterial dissections were observed in the distal group (8.9%, n = 4 vs. 2.6%, n = 1; p = 0.36). In the distal group, one patient with vascular injury died due to complications. No cases of emboli in new territory were observed.
Distal tip position of the distal access catheter has a significant impact on reperfusion in patients with acute ischemic stroke. However, there was also a higher rate of vascular injury as the catheter was advanced further. If advancement to the target lesion is too difficult, placing it in the cavernous internal carotid artery may be a viable method without complications.
在急性脑卒中患者中，使用支架取栓联合远端通路导管进行机械血栓切除术，可能会提高血管再通率和临床转归。本研究旨在比较两种不同的血栓切除术技术，根据联合支架取栓抽吸技术中远端通路导管尖端的位置。
在这项回顾性研究中，根据远端通路导管尖端位置将接受联合技术治疗的大脑中动脉闭塞患者分为两组：远端组（导管放置在血栓附近）和近端组（导管放置在眼动脉下方的颈内动脉海绵窦段）。比较两组患者的基线特征、血管造影结果和临床转归。
共纳入 83 例患者（远端组 45 例，近端组 38 例）。远端组完全再通率更高（未加权分析：66.7%比 42.1%，p=0.025；加权分析：74.0%比 28.8%，p=0.002）。多变量分析显示，远端尖端位置与完全再通独立相关（未加权分析：优势比，4.10；95%可信区间，1.40-11.98；p=0.01；加权分析：优势比，5.20；95%可信区间，1.72-15.78；p=0.004）。远端组的临床转归和早期神经功能改善也更为有利（未加权分析：62.2%比 55.3%，p=0.521；60%比 50%，p=0.361；加权分析：62.7%比 61.1%，p=0.877；66%比 45.7%，p=0.062）。然而，远端组动脉夹层的发生率更高（8.9%，n=4 比 2.6%，n=1；p=0.36）。在远端组，1 例血管损伤患者因并发症死亡。未观察到新的血管损伤部位的栓塞。
远端通路导管尖端的位置对急性缺血性脑卒中患者的再灌注有显著影响。然而，随着导管进一步推进，血管损伤的发生率也更高。如果向目标病变推进太困难，将其放置在颈内动脉海绵窦段可能是一种可行的方法，且没有并发症。
