Department of Neurosurgery, Kamagaya General Hospital, 929-6 Hatsutomi, 273-0121, Kamagaya-shi, Chiba, Japan.
Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.
Clin Neuroradiol. 2023 Jun;33(2):509-518. doi: 10.1007/s00062-022-01240-4. Epub 2022 Dec 22.
This study aimed to identify factors related to the incidence of post-thrombectomy subarachnoid hemorrhage (PTSAH).
This retrospective, observational cohort study enrolled consecutive patients with acute ischemic stroke (AIS) due to the internal carotid artery (IC) top or middle cerebral artery (MCA) M1 or M2 segment occlusion who underwent single-pass stent retriever (SR) treatment between January 2015 and May 2022 at two acute care hospitals.
Of the 54 included patients, 10 were in the PTSAH group (18.5%). The occlusion sites were IC top (31.5%), M1 segment (48.1%), and M2 segment (20.4%). Aspiration catheters (ACs) were used in 32 (59.3%) patients; however, the combined technique (AC advancement at least to the most proximal marker of SR) was actually used in 26 (48.1%) patients because a ledge effect at the ophthalmic artery origin from the IC interfered with distal navigation of the ACs. The baseline patient characteristics did not differ between the groups. M2 segment occlusion in the PTSAH and non-PTSAH groups were 40.0% and 15.9%, respectively (p = 0.19). More ACs were used in the non-PTSAH group (65.9% vs. 30.0%, p = 0.07). Significantly fewer combined techniques were performed in the PTSAH group (10.0% vs. 56.8%, p = 0.01). In multivariate analysis adjusted by variables with M2 segment occlusion and the combined technique, the combined technique (odds ratio 0.098; 95% confidence interval, 0.011-0.887; p = 0.039) was identified as a significantly associated factor for PTSAH. There was one PTSAH case (1.9%) with symptom worsening.
The combined technique significantly influenced PTSAH occurrence as a preventive factor.
本研究旨在确定与支架取栓后蛛网膜下腔出血（PTSAH）相关的因素。
本回顾性观察性队列研究纳入了 2015 年 1 月至 2022 年 5 月期间在两家急性护理医院因颈内动脉（IC）顶部或大脑中动脉（MCA）M1 或 M2 段闭塞而接受单次通过支架取栓器（SR）治疗的急性缺血性脑卒中（AIS）连续患者。
在 54 例纳入的患者中，有 10 例（18.5%）发生 PTSAH。闭塞部位为 IC 顶部（31.5%）、M1 段（48.1%）和 M2 段（20.4%）。32 例（59.3%）患者使用抽吸导管（AC）；然而，实际使用了联合技术（AC 推进至至少 SR 的最近端标记）的患者为 26 例（48.1%），因为在 IC 起源处的眼动脉有一个隆起效应，阻碍了 AC 的远端导航。两组患者的基线特征无差异。PTSAH 和非 PTSAH 组的 M2 段闭塞分别为 40.0%和 15.9%（p=0.19）。非 PTSAH 组使用更多的 AC（65.9%比 30.0%，p=0.07）。在 PTSAH 组中，联合技术的使用率显著较低（10.0%比 56.8%，p=0.01）。在调整了 M2 段闭塞和联合技术的变量的多变量分析中，联合技术（比值比 0.098；95%置信区间，0.011-0.887；p=0.039）被确定为 PTSAH 的显著相关因素。有 1 例 PTSAH 病例（1.9%）出现症状恶化。
联合技术作为预防因素显著影响 PTSAH 的发生。
