Hernández David, Serrano Elena, Molins Gemma, Zarco Federico, Chirife Oscar, Werner Mariano, Lara Blanca, Ramos Anna, Llull Laura, Requena Manuel, Cuevas Marta de Dios Las, Remollo Sebastián, Piñana Carlos, López-Rueda Antonio
Hospital Universitario Valle de Hebrón, Barcelona, Spain.
Hospital Clínic de Barcelona, Barcelona, Spain.
Front Neurol. 2022 Jun 30;13:925159. doi: 10.3389/fneur.2022.925159. eCollection 2022.
The purpose of this study is to evaluate the best endovascular approach (aspiration or stent-retriever) and the impact of stent retriever size and length on clinical and angiographic outcomes in patients with acute intracranial ICA occlusion. We conducted a retrospective analysis of a prospective database of consecutive patients with acute intracranial ICA occlusion undergoing endovascular treatment in four Comprehensive Stroke Center between June-2019 and December-2020. We include 121 patients; Stent-retriever (SR) was used as first technical approach in 107 patients (88.4%) and aspiration was used in 14 patients (11.6%). SR group had higher rate of FPE compared to aspiration group (29 vs. 0%, = 0.02). In SR subgroup, treatment highlighted higher FPE in the 6 × 50 SR (37.7%), than in the rest of the SR which are 21.2% (4-5 mm size and 20-50 mm length SR) and 19% (6 mm size and 25-40 mm length SR), but it was not found to be statistically significant. There were no other significant differences across the groups regarding primary angiographic or clinical outcomes. In our intracranial ICA occlusion series, stent retrievers were superior to direct aspiration in obtaining FPEs and mFPEs, and longer devices achieved better results with no statistically significant difference. Further studies evaluating the effects of different ICA clot removal approaches are warranted to confirm these results.
本研究的目的是评估最佳的血管内治疗方法（抽吸或取栓支架）以及取栓支架的尺寸和长度对急性颅内颈内动脉闭塞患者临床和血管造影结果的影响。我们对2019年6月至2020年12月期间在四个综合卒中中心接受血管内治疗的连续急性颅内颈内动脉闭塞患者的前瞻性数据库进行了回顾性分析。我们纳入了121例患者；107例患者（88.4%）将取栓支架（SR）作为首选技术方法，14例患者（11.6%）采用了抽吸方法。与抽吸组相比，SR组的首次再通率更高（29%对0%，P = 0.02）。在SR亚组中，6×50 SR的治疗首次再通率较高（37.7%），高于其余SR（4-5mm尺寸和20-50mm长度的SR为21.2%，6mm尺寸和25-40mm长度的SR为19%），但未发现具有统计学意义。在主要血管造影或临床结果方面，各组之间没有其他显著差异。在我们的颅内颈内动脉闭塞系列研究中，取栓支架在实现首次再通和改良首次再通方面优于直接抽吸，更长的器械取得了更好的结果，但无统计学显著差异。有必要进行进一步研究以评估不同颈内动脉血栓清除方法的效果，以证实这些结果。
