Herzberg Moriz, Dorn Franziska, Trumm Christoph, Kellert Lars, Tiedt Steffen, Feil Katharina, Küpper Clemens, Wollenweber Frank, Liebig Thomas, Zimmermann Hanna
Institute of Neuroradiology, Ludwig Maximilian University (LMU), 80539 Munich, Germany.
Department of Radiology, University Hospital Würzburg, 97080 Würzburg, Germany.
J Clin Med. 2022 Aug 8;11(15):4619. doi: 10.3390/jcm11154619.
There is ongoing debate concerning the safety and efficacy of various mechanical thrombectomy (MT) approaches for M2 occlusions. We compared these for MT in M2 versus M1 occlusions. Subgroup analyses of different technical approaches within the M2 MT cohort were also performed. Patients were included from the German Stroke Registry (GSR), a multicenter registry of consecutive MT patients. Primary outcomes were reperfusion success events. Secondary outcomes were early clinical improvement (improvement in NIHSS score > 4) and independent survival at 90 days (mRS 0−2). Out of 3804 patients, 2689 presented with M1 (71%) and 1115 with isolated M2 occlusions (29%). The mean age was 76 (CI 65−82) and 77 (CI 66−83) years, respectively. Except for baseline NIHSS (15 (CI 10−18) vs. 11 (CI 6−16), p < 0.001) and ASPECTS (9 (CI 7−10) vs. 9 (CI 8−10, p < 0.001), baseline demographics were balanced. Apart from a more frequent use of dedicated small vessel stent retrievers (svSR) in M2 (17.4% vs. 3.0; p < 0.001), intraprocedural aspects were balanced. There was no difference in ICH at 24 h (11%; p = 1.0), adverse events (14.4% vs. 18.1%; p = 0.63), clinical improvement (62.5% vs. 61.4 %; p = 0.57), mortality (26.9% vs. 22.9%; p = 0.23). In M2 MT, conventional stent retriever (cSR) achieved higher rates of mTICI3 (54.0% vs. 37.7−42.0%; p < 0.001), requiring more MT-maneuvers (7, CI 2−8) vs. 2 (CI 2−7)/(CI 2−2); p < 0.001) and without impact on efficacy and outcome. Real-life MT in M2 can be performed with equal safety and efficacy as in M1 occlusions. Different recanalization techniques including the use of svSR did not result in significant differences regarding safety, efficacy and outcome.
关于各种机械取栓（MT）方法治疗M2段闭塞的安全性和有效性，目前仍存在争议。我们比较了MT治疗M2段与M1段闭塞的情况。还对M2 MT队列中不同技术方法进行了亚组分析。患者来自德国卒中登记处（GSR），这是一个连续MT患者的多中心登记处。主要结局是再灌注成功事件。次要结局是早期临床改善（美国国立卫生研究院卒中量表[NIHSS]评分改善>4分）和90天时的独立生存（改良Rankin量表[mRS] 0 - 2分）。在3804例患者中，2689例为M1段闭塞（71%），1115例为孤立的M2段闭塞（29%）。平均年龄分别为76岁（可信区间[CI] 65 - 82岁）和77岁（CI 66 - 83岁）。除基线NIHSS（15分[CI 10 - 18分] vs. 11分[CI 6 - 16分]，p < 0.001）和脑缺血早期CT评分（ASPECTS）（9分[CI 7 - 10分] vs. 9分[CI 8 - 10分]，p < 0.001）外，基线人口统计学特征是平衡的。除了M2段更频繁使用专用小血管支架取栓器（svSR）（17.4% vs. 3.0%；p < 0.001）外，术中情况是平衡的。24小时内颅内出血（ICH）无差异（11%；p = 1.0），不良事件无差异（14.4% vs. 18.1%；p = 0.63），临床改善无差异（62.5% vs. 61.4%；p = 0.57），死亡率无差异（26.9% vs. 22.9%；p = 0.23）。在M2 MT中，传统支架取栓器（cSR）实现更高的脑梗死溶栓分级（mTICI）3级率（54.0% vs. 37.7% - 42.0%；p < 0.001），需要更多的MT操作（7次，CI 2 - 8次） vs. 2次（CI 2 - 7次）/（CI 2 - 2次）；p < 0.001），且对疗效和结局无影响。M₂段的实际MT操作与M₁段闭塞具有同等的安全性和有效性。不同的再通技术，包括使用svSR，在安全性、有效性和结局方面没有显著差异。
