Department of Neurology, University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA.
Department of Clinical Research, Valley Baptist Medical Center - Harlingen, Harlingen, Texas, USA.
Interv Neuroradiol. 2022 Aug;28(4):419-425. doi: 10.1177/15910199211039403. Epub 2021 Sep 13.
To investigate whether significant differences exist in recanalization rates and primary outcomes between patients who undergo mechanical thrombectomy alone versus those who undergo mechanical thrombectomy with acute intracranial stenting.
Through the utilization of a prospectively collected endovascular database at a comprehensive stroke center between 2012 and 2020, variables such as demographics, co-morbid conditions, symptomatic intracerebral hemorrhage, mortality rate at discharge, and good/poor outcomes in regard to modified thrombolysis in cerebral infarction score and modified Rankin Scale were examined. The outcomes between patients receiving acute intracranial stenting + mechanical thrombectomy and patients that underwent mechanical thrombectomy alone were compared.
There were a total of 420 acute ischemic stroke patients who met criteria for the study (average age 70.6 ± 13.01 years; 46.9% were women). Analysis of 46 patients from the acute stenting + mechanical thrombectomy group (average age 70.34 ± 13.75 years; 37.0% were women), and 374 patients from the mechanical thrombectomy alone group (average age 70.64 ± 12.92 years; 48.1% were women). Four patients (8.7%) in the acute stenting + mechanical thrombectomy group experienced intracerebral hemorrhage versus 45 patients (12.0%) in the mechanical thrombectomy alone group ( = 0.506); no significant increases were noted in the median length of stay (7 vs 8 days; = 0.208), rates of modified thrombolysis in cerebral infarction 2B-3 recanalization ( = 0.758), or good modified Rankin Scale scores ( = 0.806).
Acute intracranial stenting in addition to mechanical thrombectomy was not associated with an increase in overall length of stay, intracerebral hemorrhage rates, or any change in discharge modified Rankin Scale. Further research is required to determine whether mechanical thrombectomy and acute intracranial stenting in acute ischemic stroke patients is unsafe.
探讨单纯机械血栓切除术与机械血栓切除术联合急性颅内支架置入术患者的再通率和主要结局是否存在显著差异。
通过在 2012 年至 2020 年期间利用综合卒中中心前瞻性收集的血管内数据库，检查了人口统计学、合并症、症状性颅内出血、出院时死亡率以及改良脑梗死溶栓评分和改良 Rankin 量表的良好/不良结局等变量。比较了接受急性颅内支架置入术+机械血栓切除术的患者与单独行机械血栓切除术的患者的结局。
共有 420 例符合研究标准的急性缺血性脑卒中患者（平均年龄 70.6±13.01 岁；46.9%为女性）。分析了急性支架置入术+机械血栓切除术组的 46 例患者（平均年龄 70.34±13.75 岁；37.0%为女性）和单纯机械血栓切除术组的 374 例患者（平均年龄 70.64±12.92 岁；48.1%为女性）。急性支架置入术+机械血栓切除术组 4 例（8.7%）患者发生颅内出血，单纯机械血栓切除术组 45 例（12.0%）（ = 0.506）；中位住院时间无显著增加（7 天 vs 8 天； = 0.208），改良脑梗死溶栓评分 2B-3 再通率（ = 0.758）或良好的改良 Rankin 量表评分（ = 0.806）无显著变化。
急性颅内支架置入术联合机械血栓切除术并不增加总住院时间、颅内出血率或改变出院时改良 Rankin 量表评分。需要进一步研究以确定急性缺血性脑卒中患者行机械血栓切除术和急性颅内支架置入术是否不安全。
