Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
Neuroradiology Department, Toulouse University Hospital, Toulouse, France.
Eur J Neurol. 2024 Dec;31(12):e16467. doi: 10.1111/ene.16467. Epub 2024 Sep 9.
Vasospasm is a common iatrogenic event during mechanical thrombectomy (MT). In such circumstances, intra-arterial nimodipine administration is occasionally considered. However, its use in the treatment of iatrogenic vasospasm during MT has been poorly studied. We investigated the impact of iatrogenic vasospasm treated with intra-arterial nimodipine on outcomes after MT for large vessel occlusion stroke.
We conducted a retrospective analysis of the multicenter observational registry Endovascular Treatment in Ischemic Stroke (ETIS). Consecutive patients treated with MT between January 2015 and December 2022 were included. Patients treated with medical treatment alone, without MT, were excluded. We also excluded patients who received another in situ vasodilator molecule during the procedure. Outcomes were compared according to the occurrence of cervical and/or intracranial arterial vasospasm requiring intraoperative use of in situ nimodipine based on operator's decision, using a propensity score approach. The primary outcome was a modified Rankin Scale (mRS) score of 0-2 at 90 days. Secondary outcomes included excellent outcome (mRS score 0-1), final recanalization, mortality, intracranial hemorrhage and procedural complications. Secondary analyses were performed according to the vasospasm location (intracranial or cervical).
Among 13,678 patients in the registry during the study period, 434 received intra-arterial nimodipine for the treatment of MT-related vasospasm. In the main analysis, comparable odds of favorable outcome were observed, whereas excellent outcome was significantly less frequent in the group with vasospasm requiring nimodipine (adjusted odds ratio [aOR] 0.78, 95% confidence interval [CI] 0.63-0.97). Perfect recanalization, defined as a final modified Thrombolysis In Cerebral Infarction score of 3 (aOR 0.63, 95% CI 0.42-0.93), was also rarer in the vasospasm group. Intracranial vasospasm treated with nimodipine was significantly associated with worse clinical outcome (aOR 0.64, 95% CI 0.45-0.92), in contrast to the cervical location (aOR 1.37, 95% CI 0.54-3.08).
Arterial vasospasm occurring during the MT procedure and requiring intra-arterial nimodipine administration was associated with worse outcomes, especially in case of intracranial vasospasm. Although this study cannot formally differentiate whether the negative consequences were due to the vasospasm itself, or nimodipine administration or both, there might be an important signal toward a substantial clinical impact of iatrogenic vasospasm during MT.
血管痉挛是机械血栓切除术（MT）过程中常见的医源性事件。在这种情况下，偶尔会考虑动脉内尼莫地平给药。然而，其在 MT 期间治疗医源性血管痉挛的应用研究甚少。我们研究了 MT 后治疗医源性血管痉挛对大血管闭塞性卒中的影响。
我们对多中心观察性登记处血管内治疗缺血性卒中（ETIS）进行了回顾性分析。纳入 2015 年 1 月至 2022 年 12 月期间接受 MT 治疗的连续患者。排除仅接受药物治疗且未接受 MT 的患者。我们还排除了在手术过程中使用其他原位血管扩张剂分子的患者。根据操作者的决定，根据发生需要术中使用原位尼莫地平的颈内和/或颅内动脉血管痉挛的情况，使用倾向评分方法比较结果。主要结局为 90 天改良 Rankin 量表（mRS）评分 0-2。次要结局包括优秀结局（mRS 评分 0-1）、最终再通、死亡率、颅内出血和程序并发症。根据血管痉挛位置（颅内或颈内）进行了二次分析。
在研究期间登记处的 13678 名患者中，434 名患者因 MT 相关血管痉挛接受了动脉内尼莫地平治疗。在主要分析中，观察到良好结局的可能性相当，而需要尼莫地平治疗血管痉挛的组中优秀结局明显较少（调整优势比[aOR]0.78，95%置信区间[CI]0.63-0.97）。定义为最终改良脑梗死溶栓评分 3 分的完美再通（aOR 0.63，95%CI 0.42-0.93）也较少见。与颈内位置（aOR 1.37，95%CI 0.54-3.08）相比，颅内血管痉挛用尼莫地平治疗与更差的临床结局显著相关（aOR 0.64，95%CI 0.45-0.92）。
MT 过程中发生的动脉血管痉挛并需要动脉内尼莫地平给药与更差的结局相关，尤其是颅内血管痉挛的情况。尽管本研究不能正式区分这些负面后果是由于血管痉挛本身、尼莫地平给药还是两者共同作用，但在 MT 期间发生医源性血管痉挛可能会对临床结果产生重要影响。
