Kobayashi Satoshi, Osanai Toshiya, Fujima Noriyuki, Hamaguchi Akiyoshi, Sugiyama Taku, Nakamura Toshitaka, Hida Kazutoshi, Fujimura Miki
Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Sapporo Asabu Neurosurgical Hospital, Sapporo, Japan.
Cerebrovasc Dis Extra. 2022;12(1):47-52. doi: 10.1159/000524112. Epub 2022 Mar 17.
The aim of this study was to clarify whether magnetic resonance angiography (MRA)-based road mapping of the para-aortic transfemoral access route can reduce the procedural time of mechanical thrombectomy in patients with acute ischemic stroke. We further investigated the role of pre-procedural MRA-based road mapping in optimal initial catheter selection for rapid mechanical thrombectomy.
We retrospectively reviewed 57 consecutive patients with acute ischemic stroke who underwent mechanical thrombectomy at our hospital between April 2018 and May 2021. Twenty-nine patients underwent MRA-based road mapping to visualize the para-aortic access route, whereas 28 patients only underwent routine head magnetic resonance imaging/angiography without MRA-based road mapping before neuro-interventional procedures. We then compared the basic procedural times required for mechanical thrombectomy, such as the time from femoral artery puncture to recanalization ("puncture to recanalization time") and the time from the admission to recanalization ("door to recanalization time"), between the groups.
MRA-based road mapping significantly reduced the "puncture to recanalization time" (52.0 min vs. 70.0 min; p = 0.019) and the "door to recanalization time" (146 min vs. 183 min; p = 0.013).
MRA-based road mapping of the para-aortic access route is useful to reduce the procedural time of mechanical thrombectomy in acute stroke patients, possibly by enabling optimal initial catheter selection during the procedure.
本研究的目的是阐明基于磁共振血管造影（MRA）的腹主动脉旁经股动脉入路路线图是否能减少急性缺血性脑卒中患者机械取栓的手术时间。我们进一步研究了术前基于MRA的路线图在快速机械取栓最佳初始导管选择中的作用。
我们回顾性分析了2018年4月至2021年5月在我院接受机械取栓的57例连续急性缺血性脑卒中患者。29例患者接受了基于MRA的路线图以可视化腹主动脉旁入路路线，而28例患者在神经介入手术前仅接受了常规头部磁共振成像/血管造影，未进行基于MRA的路线图。然后我们比较了两组之间机械取栓所需的基本手术时间，如从股动脉穿刺到再通的时间（“穿刺到再通时间”）和从入院到再通的时间（“门到再通时间”）。
基于MRA的路线图显著缩短了“穿刺到再通时间”（52.0分钟对70.0分钟；p = 0.019）和“门到再通时间”（146分钟对183分钟；p = 0.013）。
基于MRA的腹主动脉旁入路路线图有助于减少急性脑卒中患者机械取栓的手术时间，可能是通过在手术过程中实现最佳初始导管选择。
