Oka Fumiaki, Nishimoto Takuma, Mori Naomasa, Kawano Akiko, Ishihara Hideyuki
Department of Neurosurgery, Yamaguchi Graduate School of Medicine, Ube, Yamaguchi, Japan.
Interv Neuroradiol. 2024 Aug 7:15910199241270706. doi: 10.1177/15910199241270706.
The prognostic relevance of post-mechanical thrombectomy (MT) subarachnoid hemorrhage (SAH) remains controversial. This study aimed to investigate whether the thickness of the SAH clot affects clinical outcomes following MT for M2 occlusion.
A retrospective analysis was conducted on a prospective database of patients who underwent MT for isolated M2 occlusion. Patients were categorized into three groups based on the presence and thickness of SAH. Clinical and angiographical characteristics and outcomes were compared.
Of the 36 patients included, SAH was observed in 15 (42%). When comparing patients with no SAH (grade 0) or thin SAH (grade 1) (N = 28) with those who had thick SAH (grade 2) (N = 8), patients with Grade 2 SAH required a higher number of passes and had a more severe angulation at M2. Patients with SAH Grade 2 had significantly worse NIHSS scores at 24 h (median, 4 vs. 14), but only one patient was identified as having a symptomatic intracranial hemorrhage. Patients with SAH Grade 2 were found to have a lower rate of favorable outcome (modified Rankin scale 0-2) (23% vs. 75%, P = 0.0026) and higher mortality (25% vs. 0%, P = 0.0499) at 90 days.
The study found that thick SAH prevents clinical recovery after MT for M2 occlusion, even in cases of successful recanalization, and is associated with an unfavorable outcome. Thick SAH after MT is also linked to an increase in the number of passes and severe angulation at the M2 segment.
机械取栓（MT）后蛛网膜下腔出血（SAH）的预后相关性仍存在争议。本研究旨在调查SAH血凝块厚度是否会影响M2段闭塞患者MT后的临床结局。
对因孤立性M2段闭塞接受MT的患者的前瞻性数据库进行回顾性分析。根据SAH的存在情况和厚度将患者分为三组。比较临床和血管造影特征及结局。
纳入的36例患者中，15例（42%）观察到SAH。将无SAH（0级）或薄SAH（1级）患者（N = 28）与厚SAH（2级）患者（N = 8）进行比较时，2级SAH患者需要更多次数的操作，且M2段的成角更严重。2级SAH患者在24小时时的美国国立卫生研究院卒中量表（NIHSS）评分明显更差（中位数，4分对14分），但仅1例患者被确定为有症状性颅内出血。发现2级SAH患者在90天时的良好结局率（改良Rankin量表0 - 2分）较低（23%对75%，P = 0.0026），死亡率较高（25%对0%，P = 0.0499）。
研究发现，即使在成功再通的情况下，厚SAH也会阻碍M2段闭塞患者MT后的临床恢复，并与不良结局相关。MT后厚SAH还与操作次数增加和M2段严重成角有关。
