Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
Interventional Neuroradiology, Hôpital de la Cavale Blanche, Brest, Bretagne, France.
J Neurointerv Surg. 2023 Jan;15(1):27-33. doi: 10.1136/neurintsurg-2021-018180. Epub 2022 Jan 6.
Novel thrombectomy strategies emanate expeditiously day-by-day counting on access system, clot retriever device, proximity to and integration with the thrombus, and microcatheter disengagement. Nonetheless, the relationship between native thrombectomy strategies and revascularization success remains to be evaluated in basilar artery occlusion (BAO).
To compare the safety and efficacy profile of key frontline thrombectomy strategies in BAO.
Retrospective analyses of prospectively maintained stroke registries at two comprehensive stroke centers were performed between January 2015 and December 2019. Patients with BAO selected after MR imaging were categorized into three groups based on the frontline thrombectomy strategy (contact aspiration (CA), stent retriever (SR), or combined (SR+CA)). Patients who experienced failure of clot retrieval followed by an interchanging strategy were categorized as a fourth (switch) group. Clinicoradiological features and procedural variables were compared. The primary outcome measure was the rate of complete revascularization (modified Thrombolysis in Cerebral Infarction (mTICI) grade 2c-3). Favorable outcome was defined as a 90 day modified Rankin Scale score of 0-2.
Of 1823 patients, we included 128 (33 underwent CA, 35 SR, 35 SR +CA, and 25 switch techniques). Complete revascularization was achieved in 83/140 (59%) primarily analyzed patients. SR +CA was associated with higher odds of complete revascularization (adjusted OR 3.04, 95% CI 1.077 to 8.593, p=0.04) which was an independent predictor of favorable outcome (adjusted OR 2.73. 95% CI 1.152 to 6.458, p=0.02). No significant differences were observed for symptomatic intracranial hemorrhage, functional outcome, or mortality rate.
Among BAO patients, the combined technique effectively contributed to complete revascularization that showed a 90 day favorable outcome with an equivalent complication rate after thrombectomy.
新型取栓策略层出不穷，取栓技术与入路系统、血栓取出装置、与血栓的距离和整合以及微导管解脱等因素息息相关。然而，在基底动脉闭塞（BAO）中，仍需评估原始取栓策略与再通成功之间的关系。
比较 BAO 中关键一线取栓策略的安全性和疗效特征。
对 2015 年 1 月至 2019 年 12 月期间在两家综合卒中中心进行的前瞻性卒中登记处进行回顾性分析。在 MRI 选择 BAO 患者后，根据一线取栓策略（接触抽吸（CA）、支架取栓（SR）或联合（SR+CA））将患者分为三组。对经历血栓取出失败后采用交换策略的患者归入第四组（转换）。比较临床和影像学特征以及程序变量。主要结局测量是完全再通率（改良脑梗死溶栓（mTICI）分级 2c-3）。良好的结局定义为 90 天时改良 Rankin 量表评分为 0-2 分。
在 1823 名患者中，我们纳入了 128 名患者（33 名接受 CA 治疗，35 名接受 SR 治疗，35 名接受 SR+CA 治疗，25 名接受转换技术治疗）。在主要分析的 140 名患者中，83 名（59%）患者达到完全再通。SR+CA 与更高的完全再通几率相关（校正优势比 3.04，95%置信区间 1.077 至 8.593，p=0.04），这是良好结局的独立预测因素（校正优势比 2.73，95%置信区间 1.152 至 6.458，p=0.02）。在症状性颅内出血、功能结局或死亡率方面未观察到显著差异。
在 BAO 患者中，联合技术可有效实现完全再通，取栓后 90 天的良好结局与并发症发生率相当。
