Ishiguro Taichi, Kawashima Akitsugu, Nomura Shunsuke, Hashimoto Kazutoshi, Hodotsuka Kenichi, Kawamata Takakazu
Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Chiba, Japan.
Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
J Neuroendovasc Ther. 2021;15(4):207-212. doi: 10.5797/jnet.oa.2020-0054. Epub 2020 Oct 20.
Mechanical thrombectomy for acute large vessel occlusion (LVO) is currently widely performed. However, rescue treatment (RT), such as percutaneous transluminal angioplasty (PTA) and stenting, is occasionally required, particularly in the case of atherothrombotic brain infarction (ATBI) or dissection. As RT requires higher levels of therapeutic skills and additional devices, early prediction of its performance and preparation are important. We retrospectively investigated the pre-therapeutic factors for predicting the necessity of RT.
We reviewed 149 consecutive patients who underwent mechanical thrombectomy for acute LVO between April 2014 and December 2019. Eight patients were excluded because of missing clinical data. RT was performed when severe stenosis was observed in occluded vessels or proximal to them during mechanical thrombectomy. We investigated pre-therapeutic neurological, laboratory, and radiological findings in the 141 remaining patients, and compared them between RT and non-RT groups.
RT was performed on 23 of the 141 patients. We found four pre-therapeutic factors with significantly different rates between RT/non-RT as follows: (1) Atrial fibrillation 8.7%/71.1% (p <0.001), (2) diabetes mellitus 39.1%/19.5% (p = 0.04), (3) susceptibility vessel sign (SVS) by T2-weighted imaging 17.4%/66.1% (p <0.001), and (4) tapered occlusion by magnetic resonance angiography (MRA) 47.8%/11.9% (p <0.001). The plasma level of brain natriuretic peptide (BNP) was also significantly different between the two groups. When the BNP level was less than 70 pg/mL, the sensitivity for being in the RT group was 86.9% and the specificity was 83.5%.
Pre-therapeutic findings, such as diabetes mellitus, tapered occlusion, absence of atrial fibrillation, negative SVS, and BNP level less than 70 pg/mL, are predictors of RT in mechanical thrombectomy.
急性大血管闭塞（LVO）的机械取栓术目前应用广泛。然而，有时需要进行挽救性治疗（RT），如经皮腔内血管成形术（PTA）和支架置入术，尤其是在动脉粥样硬化血栓形成性脑梗死（ATBI）或夹层的情况下。由于RT需要更高水平的治疗技能和额外的设备，早期预测其实施情况并做好准备很重要。我们回顾性研究了预测RT必要性的治疗前因素。
我们回顾了2014年4月至2019年12月期间连续149例行急性LVO机械取栓术的患者。8例患者因临床数据缺失被排除。在机械取栓过程中，当闭塞血管或其近端出现严重狭窄时进行RT。我们调查了其余141例患者的治疗前神经学、实验室和影像学检查结果，并在RT组和非RT组之间进行了比较。
141例患者中有23例进行了RT。我们发现有四个治疗前因素在RT组和非RT组之间的发生率有显著差异，如下：（1）心房颤动8.7%/71.1%（p<0.001），（2）糖尿病39.1%/19.5%（p=0.04），（3）T2加权成像显示的易损血管征（SVS）17.4%/66.1%（p<0.001），以及（4）磁共振血管造影（MRA）显示的锥形闭塞47.8%/11.9%（p<0.001）。两组间脑利钠肽（BNP）的血浆水平也有显著差异。当BNP水平低于70 pg/mL时，在RT组中的敏感性为86.9%，特异性为83.5%。
治疗前的检查结果，如糖尿病、锥形闭塞、无心房颤动、SVS阴性以及BNP水平低于70 pg/mL，是机械取栓术中RT的预测指标。
