Goldman Daryl, Reddi Preethi, Al-Kawaz Mais, Yaeger Kurt A, Hardigan Trevor, Mehta Amol, Scaggiante Jacopo, Tomalty Robert Dana, Gulotta Paul, Fennell Vernard, Vidal Gabriel A, Poongkunran Mugilan, Milburn James M, Majidi Shahram
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Neurointerv Surg. 2025 Jun 1;17(e2):e345-e348. doi: 10.1136/jnis-2024-022026.
Higher positioning of a large bore guide catheter during endovascular thrombectomy (EVT) is hypothesized to potentially improve thrombectomy success.
To evaluate the safety and efficacy of intracranial guide catheter placement during EVT using a multicenter database.
We reviewed data on consecutive patients undergoing EVT for anterior circulation large vessel occlusion (LVO) at three comprehensive stroke centers between October 2019 and December 2022. Participants were allocated to one of two cohorts: intracranial (n=141)-guide catheter tip positioned in the petrous carotid or further distal; and control (n=285)-guide catheter tip below the petrous carotid. Primary outcome was excellent reperfusion (Thrombolysis in Cerebral Ischemia (TICI) 2c or better), first pass effect (TICI 2c or better after one pass), and arterial access to final reperfusion time. The unpaired t-test, Mann-Whitney U test, and Fisher's exact test were used to compare themeans, medians and proportions of the two groups, respectively. P values & lt;0.05 were considered statistically significant two cohorts.
A total of 426 patients were included in the analysis. Patients with guide catheter location in the petrous segment or further distal had a significantly higher first-pass effect (111/284, 39.1% vs 37/141, 26.2%, P=0.009). There was no significant difference in final excellent recanalization rates between groups (202/285, 70.9% vs 92/141, 65.2%, P=0.266). Furthermore, intracranial positioning of the guide catheter was associated with significantly shorter time to final recanalization (median 21.0 (13.0-38.0) min vs 30.0 (17.0-48.0) min, P<0.001).
Positioning a large bore guide catheter in the petrous segment or further distal resulted in a significantly higher rate of first pass effect, faster procedural times, and equivalent final excellent reperfusion rates compared with more proximal guide catheter placement for patients with anterior circulation LVO.
血管内血栓切除术（EVT）期间将大口径导引导管放置得更高被认为可能会提高血栓切除术的成功率。
利用多中心数据库评估EVT期间颅内导引导管置入的安全性和有效性。
我们回顾了2019年10月至2022年12月期间在三个综合卒中中心接受前循环大血管闭塞（LVO）的EVT连续患者的数据。参与者被分配到两个队列之一：颅内（n = 141）——导引导管尖端位于岩骨段颈动脉或更远端；以及对照组（n = 285）——导引导管尖端位于岩骨段颈动脉下方。主要结局为良好再灌注（脑缺血溶栓（TICI）2c级或更好）、首次通过效应（一次通过后TICI 2c级或更好）以及动脉入路至最终再灌注时间。分别使用未配对t检验、Mann-Whitney U检验和Fisher精确检验来比较两组的均值、中位数和比例。P值<0.05被认为具有统计学意义。
共有426例患者纳入分析。导引导管位于岩骨段或更远端的患者首次通过效应显著更高（111/284，39.1%对37/141，26.2%，P = 0.009）。两组之间最终良好再通率无显著差异（202/285，70.9%对92/141，65.2%，P = 0.266）。此外，导引导管颅内定位与至最终再通的时间显著缩短相关（中位数21.0（13.0 - 38.0）分钟对30.0（17.0 - 48.0）分钟，P<0.001）。
对于前循环LVO患者，与将导引导管放置在更近端相比，将大口径导引导管放置在岩骨段或更远端可使首次通过效应发生率显著更高、手术时间更快，且最终良好再灌注率相当。
