Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea.
Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea.
Clin Neurol Neurosurg. 2024 Jan;236:108057. doi: 10.1016/j.clineuro.2023.108057. Epub 2023 Nov 18.
During stent retriever thrombectomy, a balloon guide catheter reduces distal emboli and consequently improves clinical outcomes. Because balloons are usually used before stent retrieval, these can affect the thrombus including the distal emboli while performing microcatheter navigation. This study aimed to evaluate the usefulness and safety of the pre-navigation balloon technique during microcatheter and microwire navigation.
Patients who underwent stent retriever thrombectomy secondary to an anterior circulation large-artery occlusion were retrospectively evaluated. The pre-navigation balloon technique was used, and the number of retrievals, procedure time, final recanalization, presence of distal emboli, first-pass effect (FPE), symptomatic intracranial hemorrhage including procedure-related complications, and clinical outcomes at 3 months were evaluated.
In total 123 patients were analyzed, and occurrence of distal emboli was lesser in the pre-navigation balloon than in the non-preballoon group (4.4% vs. 11.5%, p = 0.02). No statistical difference was found in successful recanalization, mortality, and procedure-related complications. Moreover, the pre-navigation balloon group had a higher FPE than the non-balloon group (37.8% vs. 20.5%, p = 0.004). Although no statistical difference was found in the pre-navigation balloon group, a trend toward a higher rate of good clinical outcomes was observed (mRS 0-2 at 3 months, 55.6% vs. 48.7%, p = 0.09). For ICA occlusion(n = 35), significant effects were seen in decreasing distal embolism (0(0%) vs 3(16%), p = 0.01), increasing FPE (8(50%) vs 6(32%), p = 0.003), and improving clinical outcomes (mRS 0-2 at 3 months, 9(56%) vs 7(37%), p = 0.03) in the pre-navigation balloon group. In the multivariate analysis, lesser distal embolism (0.91 [0.80-1.00], p = 0.02), higher successful recanalization (3.52 [1.11-7.03], p = 0.016), and higher FPE (3.17 [1.83-7.37], p = 0.001) secondary to the procedure was a predictor of favorable clinical outcomes.
The pre-navigation balloon technique significantly reduced occurrence of distal embolism and increased the FPE.
在支架取栓血栓切除术期间，球囊引导导管可减少远端栓塞，从而改善临床结果。由于球囊通常在支架取出前使用，因此在进行微导管导航时，这些球囊可能会影响血栓，包括远端栓塞。本研究旨在评估预导航球囊技术在微导管和微导丝导航中的有用性和安全性。
回顾性分析因前循环大动脉闭塞而行支架取栓血栓切除术的患者。使用预导航球囊技术，评估取栓次数、手术时间、最终再通、远端栓塞、首次通过效应（FPE）、症状性颅内出血（包括与手术相关的并发症）以及 3 个月时的临床转归。
共分析了 123 例患者，与非预球囊组相比，预球囊组的远端栓塞发生率较低（4.4% vs. 11.5%，p=0.02）。两组在再通成功、死亡率和与手术相关的并发症方面无统计学差异。此外，预球囊组的 FPE 高于非球囊组（37.8% vs. 20.5%，p=0.004）。尽管在预球囊组中未发现统计学差异，但观察到良好临床结局的比例较高（3 个月时 mRS 0-2，55.6% vs. 48.7%，p=0.09）。对于 ICA 闭塞（n=35），预球囊组在减少远端栓塞（0（0%） vs. 3（16%），p=0.01）、增加 FPE（8（50%） vs. 6（32%），p=0.003）和改善临床结局（3 个月时 mRS 0-2，9（56%） vs. 7（37%），p=0.03）方面具有显著效果。在多变量分析中，较少的远端栓塞（0.91 [0.80-1.00]，p=0.02）、更高的再通成功率（3.52 [1.11-7.03]，p=0.016）和更高的 FPE（3.17 [1.83-7.37]，p=0.001）是手术良好临床结局的预测因素。
预导航球囊技术可显著降低远端栓塞的发生，并增加 FPE。
