Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Neurointerventional Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain.
Clin Neuroradiol. 2023 Sep;33(3):701-708. doi: 10.1007/s00062-023-01264-4. Epub 2023 Mar 1.
Combined stent-retriever/large-bore distal aspiration catheter (LB-DAC) thrombectomy was recently introduced to treat large-vessel occlusion; however, it is unclear whether larger inner diameters improve outcomes. We compared angiographic and clinical outcomes in patients with occlusions of the M1 segment of the middle cerebral artery treated with mechanical thrombectomy using extra-LB-DAC versus LB-DAC in combination with stent-retrievers.
We analyzed consecutive patients with M1 occlusion included in the ROSSETTI registry treated with non-balloon guide catheter combined LB-DAC/stent-retriever thrombectomy between June 2019 and April 2022. We compared demographics, baseline clinical variables, procedural variables, angiographic outcomes, and clinical outcomes [National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) and modified Rankin scale score at 3 months] between patients treated with extra-LB-DAC (Sofia Plus, MIVI Q6, Catalyst7; inner diameter, 0.068″-0.070″) versus LB-DAC (Sofia 5F, MIVI Q5, Catalyst 6; inner diameter, 0.055″-0.064″). Primary outcome was the first-pass effect (FPE) rate, defined as near-complete/complete reperfusion (mTICI 2c-3) after a single pass of the device.
We included 324 patients (extra-LB-DAC, 185, 57.1% patients). Demographics, clinical data, and clinical outcomes were similar between the two groups; however, there was a trend towards improvement in National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) in the cohort treated with extra-LB-DAC 9 points (IQR 4;16 points) vs. 12 points (IQR 4;18 points, P = 0.083). Patients treated with extra-LB-DAC had higher FPE rate (47% vs. 30.9%; P = 0.003) and higher modified FPE (mTICI ≥ 2b after a single pass) rate (65.9% vs 46.8%; P = 0.001). The use of extra-LB-DAC was an independent factor in predicting FPE (odds ratio 1.982, 95% confidence interval 1.250-3.143, P = 0.004).
Our results suggest that in combined LB-DAC/stent-retriever thrombectomy, a larger aspiration catheter inner diameter is associated with higher rates of FPE and mFPE.
联合支架取栓/大口径远端抽吸导管（LB-DAC）血栓切除术最近被引入用于治疗大血管闭塞；然而，较大的内直径是否能改善结果尚不清楚。我们比较了使用超 LB-DAC 与 LB-DAC 联合支架取栓器治疗大脑中动脉 M1 段闭塞的患者的血管造影和临床结果。
我们分析了 2019 年 6 月至 2022 年 4 月期间在 ROSSETTI 登记处接受非球囊引导导管联合 LB-DAC/支架取栓器血栓切除术治疗的 M1 闭塞的连续患者。我们比较了两组患者的人口统计学、基线临床变量、手术变量、血管造影结果和临床结果[24 小时（24h-NIHSS）美国国立卫生研究院卒中量表评分和 3 个月改良 Rankin 量表评分（mRS）]。患者分别接受超 LB-DAC（Sofia Plus、MIVI Q6、Catalyst7；内直径 0.068”-0.070”）和 LB-DAC（Sofia 5F、MIVI Q5、Catalyst 6；内直径 0.055”-0.064”）治疗。主要结局是首次通过效果（FPE）率，定义为装置单次通过后接近完全/完全再灌注（mTICI 2c-3）。
我们纳入了 324 名患者（超 LB-DAC，185 名，57.1%的患者）。两组患者的人口统计学、临床数据和临床结果相似；然而，超 LB-DAC 治疗组 24 小时 NIHSS 评分（24h-NIHSS）改善 9 分（IQR 4；16 分），而 12 分（IQR 4；18 分，P=0.083）的趋势更明显。超 LB-DAC 治疗组的 FPE 率更高（47% vs. 30.9%；P=0.003），改良 FPE 率（单通道后 mTICI≥2b）更高（65.9% vs. 46.8%；P=0.001）。超 LB-DAC 的使用是预测 FPE 的独立因素（比值比 1.982，95%置信区间 1.250-3.143，P=0.004）。
我们的结果表明，在联合 LB-DAC/支架取栓术中，较大的抽吸导管内直径与更高的 FPE 和 mFPE 率相关。
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