孤立性大脑前动脉卒中的血栓切除术与药物治疗：一项国际多中心注册研究
Thrombectomy versus Medical Management for Isolated Anterior Cerebral Artery Stroke: An International Multicenter Registry Study.
作者信息
Meyer Lukas, Stracke Paul, Broocks Gabriel, Elsharkawy Mohamed, Sporns Peter, Piechowiak Eike I, Kaesmacher Johannes, Maegerlein Christian, Hernandez Petzsche Moritz Roman, Zimmermann Hanna, Naziri Weis, Abdullayev Nuran, Kabbasch Christoph, Diamandis Elie, Thormann Maximilian, Maus Volker, Fischer Sebastian, Möhlenbruch Markus, Weyland Charlotte S, Ernst Marielle, Jamous Ala, Meila Dan, Miszczuk Milena, Siebert Eberhard, Lowens Stephan, Krause Lars Udo, Yeo Leonard, Tan Benjamin, Gopinathan Anil, Arenillas-Lara Juan F, Navia Pedro, Raz Eytan, Shapiro Maksim, Arnberg Fabian, Zeleňák Kamil, Martínez-Galdámez Mario, Alexandrou Maria, Kastrup Andreas, Papanagiotou Panagiotis, Kemmling André, Dorn Franziska, Psychogios Marios, Andersson Tommy, Chapot René, Fiehler Jens, Hanning Uta
机构信息
From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.).
出版信息
Radiology. 2023 Apr;307(2):e220229. doi: 10.1148/radiol.220229. Epub 2023 Feb 14.
Background Evidence supporting a potential benefit of thrombectomy for distal medium vessel occlusions (DMVOs) of the anterior cerebral artery (ACA) is, to the knowledge of the authors, unknown. Purpose To compare the clinical and safety outcomes between mechanical thrombectomy (MT) and best medical treatment (BMT) with or without intravenous thrombolysis for primary isolated ACA DMVOs. Materials and Methods Treatment for Primary Medium Vessel Occlusion Stroke, or TOPMOST, is an international, retrospective, multicenter, observational registry of patients treated for DMVO in daily practice. Patients treated with thrombectomy or BMT alone for primary ACA DMVO distal to the A1 segment between January 2013 and October 2021 were analyzed and compared by one-to-one propensity score matching (PSM). Early outcome was measured by the median improvement of National Institutes of Health Stroke Scale (NIHSS) scores at 24 hours. Favorable functional outcome was defined as modified Rankin scale scores of 0-2 at 90 days. Safety was assessed by the occurrence of symptomatic intracerebral hemorrhage and mortality. Results Of 154 patients (median age, 77 years; quartile 1 [Q1] to quartile 3 [Q3], 66-84 years; 80 men; 94 patients with MT; 60 patients with BMT) who met the inclusion criteria, 110 patients (median age, 76 years; Q1-Q3, 67-83 years; 50 men; 55 patients with MT; 55 patients with BMT) were matched. DMVOs were in A2 (82 patients; 53%), A3 (69 patients; 45%), and A3 (three patients; 2%). After PSM, the median 24-hour NIHSS point decrease was -2 (Q1-Q3, -4 to 0) in the thrombectomy and -1 (Q1-Q3, -4 to 1.25) in the BMT cohort ( = .52). Favorable functional outcome (MT vs BMT, 18 of 37 [49%] vs 19 of 39 [49%], respectively; = .99) and mortality (MT vs BMT, eight of 37 [22%] vs 12 of 39 [31%], respectively; = .36) were similar in both groups. Symptomatic intracranial hemorrhage occurred in three (2%) of 154 patients. Conclusion Thrombectomy appears to be a safe and technically feasible treatment option for primary isolated anterior cerebral artery occlusions in the A2 and A3 segment with clinical outcomes similar to best medical treatment with and without intravenous thrombolysis. © RSNA, 2023 See also the editorial by Zhu and Wang in this issue.
背景 据作者所知，尚无证据支持血栓切除术对大脑前动脉（ACA）远端中等血管闭塞（DMVO）可能具有益处。目的 比较机械血栓切除术（MT）与最佳药物治疗（BMT，联合或不联合静脉溶栓）用于原发性孤立性ACA DMVO的临床和安全性结局。材料与方法 “原发性中等血管闭塞性卒中治疗研究（TOPMOST）”是一项国际性、回顾性、多中心、观察性注册研究，纳入日常实践中接受DMVO治疗的患者。对2013年1月至2021年10月期间因A1段远端原发性ACA DMVO接受血栓切除术或单纯BMT治疗的患者进行一对一倾向评分匹配（PSM）分析和比较。早期结局通过24小时美国国立卫生研究院卒中量表（NIHSS）评分的中位数改善情况来衡量。良好的功能结局定义为90天时改良Rankin量表评分为0 - 2分。通过症状性脑出血的发生情况和死亡率评估安全性。结果 在154例符合纳入标准的患者（中位年龄77岁；四分位数1[Q1]至四分位数3[Q3]，66 - 84岁；80例男性；94例接受MT治疗；60例接受BMT治疗）中，110例患者（中位年龄76岁；Q1 - Q3，67 - 83岁；50例男性；55例接受MT治疗；55例接受BMT治疗）进行了匹配。DMVO位于A2段（82例患者；53%）、A3段（69例患者；45%）和A3段（3例患者；2%）。PSM后，血栓切除组24小时NIHSS评分的中位数下降为 - 2（Q1 - Q3， - 4至0），BMT组为 - 1（Q1 - Q3， - 4至1.25）（P = 0.52）。两组的良好功能结局（MT组与BMT组分别为37例中的18例[49%]和39例中的19例[49%]；P = 0.99）和死亡率（MT组与BMT组分别为37例中的8例[22%]和39例中的12例[31%]；P = 0.36）相似。154例患者中有3例（2%）发生症状性颅内出血。结论 对于A2和A3段原发性孤立性大脑前动脉闭塞，血栓切除术似乎是一种安全且技术上可行的治疗选择，其临床结局与联合或不联合静脉溶栓的最佳药物治疗相似。©RSNA，2023 另见本期Zhu和Wang的社论。
Zotero 插件