Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
Clin Neurol Neurosurg. 2022 Nov;222:107464. doi: 10.1016/j.clineuro.2022.107464. Epub 2022 Sep 29.
This study aimed to compare treatment outcomes between patients who received Stent-retriever thrombectomy (SRT) and those who received first stenting without retrieval (FRESH) for treating emergent large vessel occlusion (ELVO) due to underlying intracranial atherosclerotic stenosis (ICAS).
Consecutive patients with intracranial ELVO who underwent endovascular treatment at Yeungnam University Medical Center between January 2017 and December 2020 were retrospectively selected. ICAS-related ELVO was defined based on a remnant stenosis of > 70 % or a lesser degree of stenosis with a tendency toward reocclusion and/or flow impairment during endovascular treatment. The patients with ICAS-related ELVO were divided into two groups: SRT and FRESH.
62 consecutive patients with ELVO due to ICAS were enrolled in this study. Among the 62 patients, 32 (51.6 %) underwent SRT, whereas 30 (48.4 %) patients underwent FRESH. There were no significant intergroup differences in the rate of successful reperfusion. However, symptomatic intracranial hemorrhage was significantly more common in the SRT group than in the FRESH group (18.8 % vs. 0 %; odds ratio [OR]: 14.962, 95 % confidence interval [CI]: 0.804-278.311, p = 0.024). Favorable functional outcomes were significantly more frequent in the FRESH group (93.3 % vs. 40.6 %, OR: 20.462, 95 % CI: 4.137-101.21, p < 0.001). The multivariate logistic analysis showed that FRESH (OR: 7.243 [95 % CI: 1.095-47.91]; p = 0.040) was an independent predictor of favorable functional outcomes.
FRESH could be a feasible solution when considering procedural simplicity and focusing on the cause of occlusion.
本研究旨在比较接受支架取栓术（SRT）和单纯支架置入术（FRESH）治疗颅内动脉粥样硬化狭窄（ICAS）相关急性大血管闭塞（ELVO）患者的治疗结局。
回顾性选取 2017 年 1 月至 2020 年 12 月在延世大学医疗中心接受血管内治疗的颅内 ELVO 连续患者。基于血管内治疗过程中残余狭窄>70%或狭窄程度较小但有再闭塞和/或血流受损倾向，将 ICAS 相关 ELVO 定义为 ICAS 相关 ELVO。将 ICAS 相关 ELVO 患者分为 SRT 和 FRESH 两组。
本研究共纳入 62 例 ICAS 相关 ELVO 患者。62 例患者中，32 例（51.6%）接受 SRT，30 例（48.4%）接受 FRESH。两组患者的再灌注成功率无显著差异。然而，SRT 组症状性颅内出血发生率明显高于 FRESH 组（18.8%比 0%；比值比[OR]：14.962，95%置信区间[CI]：0.804-278.311，p=0.024）。FRESH 组的良好功能结局发生率明显高于 SRT 组（93.3%比 40.6%，OR：20.462，95%CI：4.137-101.21，p<0.001）。多变量逻辑分析显示，FRESH（OR：7.243[95%CI：1.095-47.91]；p=0.040）是良好功能结局的独立预测因素。
当考虑手术操作简单并关注闭塞原因时，FRESH 可能是一种可行的解决方案。
