急性孤立性大脑后动脉卒中采用机械取栓治疗：单中心经验及文献复习。
Acute isolated posterior cerebral artery stroke treated with mechanical thrombectomy: A single-center experience and review of the literature.
机构信息
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, 12291University at Buffalo, Buffalo, NY, USA.
Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA.
出版信息
Interv Neuroradiol. 2023 Feb;29(1):10-19. doi: 10.1177/15910199211070949. Epub 2022 Jan 10.
BACKGROUND
Acute isolated posterior cerebral artery (PCA) occlusions account for 5-10% of all ischemic events. Due to peculiar patient presentation, the potential benefit of mechanical thrombectomy (MT) remains controversial. We evaluated the safety, feasibility, and effectiveness of MT in our patients and compared our results with the literature review conducted.
METHODS
Charts were reviewed retrospectively for consecutive patients diagnosed with acute PCA stroke who underwent MT. Demographics, procedural, and follow-up details were noted. For the literature review, a systematic search of PubMed, MEDLINE, and EMBASE databases was conducted for the keywords "posterior cerebral artery" and "thrombectomy" for articles published between January 1, 2010 and June 30, 2021. Estimated rates for recanalization, favorable outcomes (modified Rankin Scale [mRS] score 0-2), symptomatic intracerebral hemorrhage (sICH), and mortality were extracted.
RESULTS
Our cohort included 21 patients. Mean age was 71.2 years (standard deviation [SD] ± 10.2). Median National Institutes of Health Stroke Scale (NIHSS) presentation score was 9 (interquartile range [IQR] 5-15), with visual symptoms reported in 12(57.1%) patients. Overall, final modified thrombolysis in cerebral infarction (mTICI) 2b-3 was achieved in 17 patients (80.9%) with first-pass mTICI 2b-3 attained in 8 (38.1%). Postprocedure sICH occurred in 1 (4.8%) patient. Fifteen (71.4%) patients had a 0-2 mRS score at 90 days. Visual symptoms resolved in 10 of 12(83.3%) patients. Mortality occurred in 2 (9.5%) patients. For the systematic review, cohorts from 4 articles plus ours were included, totaling 222 patients. The estimated rate of successful recanalization was 85.25% (95% confidence interval[CI], 73.05%-97.45%), sICH was 3.60% (95% CI, 1.11%-6.09%), and mortality was 10.51% (95% CI, 5.88%-15.15%).
CONCLUSION
The results of our series and systematic review indicate MT as a potentially safe and effective treatment modality for acute PCA stroke. These results also indicate that patient selection and assessment may be the key in obtaining favorable outcomes.
背景
急性孤立性大脑后动脉（PCA）闭塞占所有缺血性事件的 5-10%。由于患者表现独特，机械血栓切除术（MT）的潜在益处仍存在争议。我们评估了 MT 在我们患者中的安全性、可行性和有效性，并与进行的文献复习结果进行了比较。
方法
回顾性分析连续诊断为急性 PCA 卒中并接受 MT 的患者的图表。记录人口统计学、程序和随访细节。为了进行文献复习，我们对 2010 年 1 月 1 日至 2021 年 6 月 30 日期间发表的关于“大脑后动脉”和“血栓切除术”的 PubMed、MEDLINE 和 EMBASE 数据库进行了系统搜索，提取了再通率、良好结局（改良 Rankin 量表[mRS]评分 0-2）、症状性颅内出血（sICH）和死亡率的估计值。
结果
我们的队列包括 21 名患者。平均年龄为 71.2 岁（标准差[SD]±10.2）。中位国立卫生研究院卒中量表（NIHSS）就诊评分 9 分（四分位距[IQR] 5-15），12 名（57.1%）患者有视觉症状。总体而言，17 名患者（80.9%）最终实现了改良脑梗死溶栓（mTICI）2b-3，8 名（38.1%）患者实现了首次通过 mTICI 2b-3。1 名（4.8%）患者术后发生 sICH。15 名（71.4%）患者在 90 天时 mRS 评分为 0-2。12 名（83.3%）有视觉症状的患者中，10 名患者的症状得到缓解。2 名（9.5%）患者死亡。在系统综述中，我们纳入了来自 4 篇文章的队列，外加我们自己的队列，共 222 名患者。再通成功率的估计值为 85.25%（95%置信区间[CI]，73.05%-97.45%），sICH 为 3.60%（95%CI，1.11%-6.09%），死亡率为 10.51%（95%CI，5.88%-15.15%）。
结论
我们的系列和系统综述结果表明，MT 是急性 PCA 卒中的一种有潜在安全性和有效性的治疗方法。这些结果还表明，患者选择和评估可能是获得良好结局的关键。
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