Namitome Satoshi, Nagao Yoichiro, Shigehatake Yuya, Matsuo Junichi, Kawamoto Keisuke, Kuroki Kenji, Hayashi Hirotaka, Nakajima Makoto, Terasaki Tadashi, Ueda Mitsuharu, Shindo Seigo
Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.
Department of Neurology, Kumamoto University, Kumamoto, Japan.
Front Neurol. 2024 Aug 7;15:1368890. doi: 10.3389/fneur.2024.1368890. eCollection 2024.
Despite the ongoing advancements in mechanical thrombectomy for large vessel occlusions causing acute ischemic stroke, successful recanalization is not achieved in all patients. One contributing factor is the presence of fibrin-rich hard clots. We proposed a new technique called the PREMIER technique, which aims to retrieve fibrin-rich clots. This study evaluated the efficacy of the PREMIER technique on fibrin-rich and erythrocyte-rich clots by comparing it with the simple use of EmboTrap III in an vessel model.
The PREMIER technique involves partially resheathing a fully deployed EmboTrap III (CERENOVUS, Johnson & Johnson Medical Devices, Irvine, California, USA) using a microcatheter to capture and retrieve a hard clot between the inner channel and outer cages of EmboTrap III. We compared recanalization rate of the PREMIER technique with the simple use of EmboTrap III in an vessel model, occluding the M1 segment with fibrin-rich hard clots (0% erythrocyte composition) and erythrocyte-rich clots (50% erythrocyte composition).
Among the 40 procedures (10 each for the PREMIER technique and the simple use of EmboTrap III for two different clots) for fibrin-rich clots, the PREMIER technique achieved successful recanalization in all 10 cases, with a significantly higher recanalization rate than the EmboTrap III (100% vs. 50%, = 0.03). For erythrocyte-rich clots, the recanalization rate was not significantly different in the PREMIER technique compared with the simple use of EmboTrap III (80% vs. 70%, = 1.00).
The PREMIER technique is a novel technique for acute large-vessel occlusions caused by fibrin-rich hard clots that hinders successful recanalization during mechanical thrombectomy.
尽管在用于治疗导致急性缺血性卒中的大血管闭塞的机械取栓术方面不断取得进展，但并非所有患者都能成功实现再通。一个促成因素是存在富含纤维蛋白的硬血栓。我们提出了一种名为PREMIER技术的新技术，旨在取出富含纤维蛋白的血栓。本研究通过在血管模型中将其与单纯使用EmboTrap III进行比较，评估了PREMIER技术对富含纤维蛋白和富含红细胞的血栓的疗效。
PREMIER技术包括使用微导管将完全展开的EmboTrap III（CERENOVUS，强生医疗器材公司，美国加利福尼亚州欧文）部分收回，以捕获并取出EmboTrap III内通道和外笼之间的硬血栓。我们在血管模型中，用富含纤维蛋白的硬血栓（红细胞成分0%）和富含红细胞的血栓（红细胞成分50%）闭塞M1段，比较了PREMIER技术与单纯使用EmboTrap III的再通率。
在针对富含纤维蛋白血栓的40例手术中（PREMIER技术和单纯使用EmboTrap III分别针对两种不同血栓各10例），PREMIER技术在所有10例中均成功实现再通，再通率显著高于EmboTrap III（100%对50%，P = 0.03）。对于富含红细胞的血栓，PREMIER技术与单纯使用EmboTrap III相比，再通率无显著差异（80%对70%，P = 1.00）。
PREMIER技术是一种针对由富含纤维蛋白的硬血栓导致的急性大血管闭塞的新技术，这种硬血栓会阻碍机械取栓术中的成功再通。
