Charan Bheru Dan, Gaikwad Shailesh B, Jain Savyasachi, Garg Ajay, Sebastian Leve Joseph Devarajan, Srivastava M V Padma, Bhatia Rohit, Pandit Awadh Kishore, Kale Shashank Sharad
Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India.
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Asian J Neurosurg. 2024 Jun 25;19(3):462-471. doi: 10.1055/s-0044-1787984. eCollection 2024 Sep.
Stroke is a leading cause of morbidity and mortality in humans. Most strokes are ischemic in nature and early recanalization of occluded vessels determines good outcomes. Recanalization of occluded vessels depends on many angiographic and demographic features. These factors need to be identified for better patient overall outcomes. Better preoperative knowledge of factors can help in customizing our treatment approach and explaining the prognosis to the guardians of the patients. We aim to share our institutional experience with mechanical thrombectomy (MT) for stroke and studied factors that affect an angiographic recanalization of vessels A retrospective single-center study was conducted involving 104 patients who underwent MT at our institution between January 2016 and December 2019. Patient demographics, baseline characteristics, pre- and postprocedural imaging findings, and other clinical data were meticulously reviewed. We divided patients into successful recanalization (modified thrombolysis in cerebral ischemia [mTICI] 2b or 3) and unsuccessful recanalization (mTICI 2a or 1) groups and various factors were analyzed to evaluate their impact on recanalization rates. In the univariate analysis, a significant association was observed between successful recanalization and several factors: the absence of rheumatic heart disease (RHD) as a risk factor ( = 0.035), the presence of a hyperdense vessel sign ( = 0.003), and the use of treatment methods including aspiration ( = 0.031), stent retriever ( = 0.001), and Solumbra ( = 0.019). However, in the multivariate analysis, none of these factors exhibited statistical significance. The presence of RHD is a risk factor associated with poor angiographic recanalization in all three MT treatment modalities. Based on the above variables we can guide the patients/relatives prior to MT procedure for their better outcome and risk-benefit ratio.
中风是人类发病和死亡的主要原因。大多数中风本质上是缺血性的，闭塞血管的早期再通决定了良好的预后。闭塞血管的再通取决于许多血管造影和人口统计学特征。为了患者获得更好的总体预后，需要识别这些因素。术前更好地了解这些因素有助于定制我们的治疗方法，并向患者监护人解释预后情况。我们旨在分享我们机构在中风机械取栓（MT）方面的经验，并研究影响血管造影再通的因素。我们进行了一项回顾性单中心研究，纳入了2016年1月至2019年12月期间在我们机构接受MT的104例患者。对患者的人口统计学、基线特征、术前和术后影像学检查结果以及其他临床数据进行了细致回顾。我们将患者分为成功再通组（改良脑缺血溶栓[mTICI] 2b或3级）和未成功再通组（mTICI 2a或1级），并分析了各种因素以评估它们对再通率的影响。在单因素分析中，成功再通与几个因素之间存在显著关联：不存在作为危险因素的风湿性心脏病（RHD）（P = 0.035）、存在高密度血管征（P = 0.003）以及使用包括抽吸（P = 0.031）、支架取栓器（P = 0.001）和Solumbra技术（P = 0.019）在内的治疗方法。然而，在多因素分析中，这些因素均未表现出统计学意义。RHD的存在是所有三种MT治疗方式中与血管造影再通不良相关的危险因素。基于上述变量，我们可以在MT手术前指导患者/亲属，以获得更好的预后和风险效益比。
