Tanaka Yujiro, Watanabe Daisuke, Kanoko Yusuke, Inoue Aya, Kato Daichi, Igasaki Shota, Kikuta Akira, Ogasawara Motoyori, Kanemaru Kodai, Maruoka Hibiku
Department of Neurosurgery, Fujieda Municipal General Hospital, Fujieda, Japan.
Department of Neurosurgery, IMS Tokyo Katsushika General Hospital, Tokyo, Japan.
Interv Neuroradiol. 2024 Aug 8:15910199241272638. doi: 10.1177/15910199241272638.
Mechanical thrombectomy for medium vessel occlusion (MeVO) is a challenging field with limited results. In this study, we aimed at evaluating the efficacy and safety of a procedural strategy beginning with occluded vessel diameter measurement and matched aspiration catheter selection.
We retrospectively analyzed all sequentially treated patients by mechanical thrombectomy at two comprehensive stroke centers between May 2020 and April 2023, focusing on the occluded vessel diameter. We included patients who underwent thrombectomy for MeVO based on the matching strategy (a procedural approach involving vessel diameter assessment, matching aspiration catheter selection, and firm clot engagement with or without a stent retriever). We evaluated efficacy and safety using the modified Thrombolysis in the Cerebral Infarction Scale (mTICI) and intracranial hemorrhage (ICH) and procedure-related complications.
Seventy patients fulfilled the final inclusion criteria. The median occluded vessel diameter was 1.71 mm. We achieved mTICI 2b/2c/3 in 82.9% and mTICI 2c/3 in 51.4% of the cases and did not observe any symptomatic ICH. We detected asymptomatic subarachnoid hemorrhage (SAH) in 24.3% of the cases, that is, 5.6%, 20.0%, and 45.5% in the vessel diameter groups ≥2.0, 1.5-2.0, and ≤1.5 mm, respectively. The SAH incidence was significantly higher in narrower vessel groups. The occluded vessel diameter and the contact method with clots predicted clinical outcomes.
Matching strategy-based thrombectomy yields acceptable efficiency and safety results. In narrower vessels, it is optimal to engage matched aspiration catheters and clots without the assistance of conventional stent retrievers.
中血管闭塞（MeVO）的机械取栓术是一个具有挑战性的领域，目前效果有限。在本研究中，我们旨在评估一种从测量闭塞血管直径并选择匹配的抽吸导管开始的手术策略的有效性和安全性。
我们回顾性分析了2020年5月至2023年4月期间在两个综合卒中中心接受机械取栓术的所有连续治疗患者，重点关注闭塞血管直径。我们纳入了基于匹配策略（一种涉及血管直径评估、匹配抽吸导管选择以及使用或不使用支架取栓器进行牢固血栓捕获的手术方法）接受MeVO取栓术的患者。我们使用改良的脑梗死溶栓量表（mTICI）以及颅内出血（ICH）和与手术相关的并发症来评估有效性和安全性。
70名患者符合最终纳入标准。闭塞血管直径的中位数为1.71毫米。在82.9%的病例中实现了mTICI 2b/2c/3，在51.4%的病例中实现了mTICI 2c/3，并且未观察到任何有症状的ICH。我们在24.3%的病例中检测到无症状蛛网膜下腔出血（SAH），即血管直径≥2.0毫米、1.5 - 2.0毫米和≤1.5毫米的组中分别为5.6%、20.0%和45.5%。较窄血管组的SAH发生率显著更高。闭塞血管直径和与血栓的接触方式可预测临床结果。
基于匹配策略的取栓术产生了可接受的效率和安全性结果。在较窄的血管中，在不使用传统支架取栓器辅助的情况下使用匹配的抽吸导管捕获血栓是最佳选择。
