抽吸与支架取栓治疗后循环中远段中等血管闭塞性卒中：TOPMOST 研究的亚组分析。
Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study.
机构信息
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.).
Department of Interventional Neuroradiology, University Hospital Muenster, Germany (P.S.).
出版信息
Stroke. 2022 Aug;53(8):2449-2457. doi: 10.1161/STROKEAHA.121.037792. Epub 2022 Apr 21.
BACKGROUND
The optimal endovascular strategy for reperfusing distal medium-vessel occlusions (DMVO) remains unknown. This study evaluates angiographic and clinical outcomes of thrombectomy strategies in DMVO stroke of the posterior circulation.
METHODS
TOPMOST (Treatment for Primary Medium Vessel Occlusion Stroke) is an international, retrospective, multicenter, observational registry of patients treated for DMVO between January 2014 and June 2020. This study analyzed endovascularly treated isolated primary DMVO of the posterior cerebral artery in the P2 and P3 segment. Technical feasibility was evaluated with the first-pass effect defined as a modified Thrombolysis in Cerebral Infarction Scale score of 3. Rates of early neurological improvement and functional modified Rankin Scale scores at 90 days were compared. Safety was assessed by the occurrence of symptomatic intracranial hemorrhage and intervention-related serious adverse events.
RESULTS
A total of 141 patients met the inclusion criteria and were treated endovascularly for primary isolated DMVO in the P2 (84.4%, 119) or P3 segment (15.6%, 22) of the posterior cerebral artery. The median age was 75 (IQR, 62-81), and 45.4% (64) were female. The initial reperfusion strategy was aspiration only in 29% (41) and stent retriever in 71% (100), both achieving similar first-pass effect rates of 53.7% (22) and 44% (44; =0.297), respectively. There were no significant differences in early neurological improvement (aspiration: 64.7% versus stent retriever: 52.2%; =0.933) and modified Rankin Scale rates (modified Rankin Scale score 0-1, aspiration: 60.5% versus stent retriever 68.6%; =0.4). In multivariable logistic regression analysis, the time from groin puncture to recanalization was associated with the first-pass effect (adjusted odds ratio, 0.97 [95% CI, 0.95-0.99]; <0.001) that in turn was associated with early neurological improvement (aOR, 3.27 [95% CI, 1.16-9.21]; <0.025). Symptomatic intracranial hemorrhage occurred in 2.8% (4) of all cases.
CONCLUSIONS
Both first-pass aspiration and stent retriever thrombectomy for primary isolated posterior circulation DMVO seem to be safe and technically feasible leading to similar favorable rates of angiographic and clinical outcome.
背景
再通远端中等血管闭塞（DMVO）的最佳血管内策略仍不清楚。本研究评估了后循环 DMVO 卒中的血栓切除术策略的血管造影和临床结果。
方法
TOPMOST（治疗原发性中等血管闭塞性卒中）是一项国际性的、回顾性的、多中心、观察性的登记研究，纳入了 2014 年 1 月至 2020 年 6 月期间接受 DMVO 治疗的患者。本研究分析了后循环 P2 和 P3 段原发性孤立性 DMVO 的血管内治疗。通过改良的血栓溶解脑梗死量表（mTICI）评分 3 定义的初次通过效果来评估技术可行性。比较早期神经改善和 90 天的改良 Rankin 量表评分。通过症状性颅内出血和与介入相关的严重不良事件评估安全性。
结果
共有 141 例患者符合纳入标准，接受了 P2（84.4%，119 例）或后交通动脉 P3 段（15.6%，22 例）原发性孤立性 DMVO 的血管内治疗。中位年龄为 75 岁（IQR，62-81），45.4%（64 例）为女性。初始再灌注策略为单纯抽吸占 29%（41 例），支架取栓占 71%（100 例），两者初次通过效果率分别为 53.7%（22 例）和 44%（44 例；=0.297），差异无统计学意义。早期神经改善（抽吸：64.7%比支架取栓：52.2%；=0.933）和改良 Rankin 量表评分（改良 Rankin 量表评分 0-1，抽吸：60.5%比支架取栓：68.6%；=0.4）无显著差异。多变量逻辑回归分析显示，从腹股沟穿刺到再通的时间与初次通过效果相关（调整优势比，0.97[95%CI，0.95-0.99]；<0.001），而初次通过效果与早期神经改善相关（优势比，3.27[95%CI，1.16-9.21]；<0.025）。所有病例中，症状性颅内出血发生率为 2.8%（4 例）。
结论
原发性孤立性后循环 DMVO 的初次抽吸和支架取栓似乎都是安全且技术可行的，可导致相似的血管造影和临床结局。
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