神经血栓切除术失败后球囊扩张式支架与自膨式支架的比较：SAINT研究的事后分析

Balloon-mounted versus self-expandable stent in failed neurothrombectomy: a post hoc analysis of the SAINT study.

作者信息

Mohammaden Mahmoud H, Martins Pedro N, Aboul-Nour Hassan, Al-Bayati Alhamza R, Hassan Ameer E, Tekle Wondwossen, Fifi Johanna T, Majidi Shahram, Kuybu Okkes, Gross Bradley A, Lang Michael, Cortez Gustavo M, Hanel Ricardo A, Aghaebrahim Amin, Sauvageau Eric, Tarek Mohamed A, Farooqui Mudassir, Ortega-Gutierrez Santiago, Zevallos Cynthia B, Galecio-Castillo Milagros, Sheth Sunil A, Nahhas Michael, Salazar-Marioni Sergio, Nguyen Thanh N, Abdalkader Mohamad, Klein Piers, Hafeez Muhammad, Kan Peter, Tanweer Omar, Khaldi Ahmad, Li Hanzhou, Jumaa Mouhammad, Zaidi Syed F, Oliver Marion, Salem Mohamed M, Burkhardt Jan-Karl, Pukenas Bryan, Vigilante Nicholas, Penckofer Mary, Siegler James E, Peng Sophia, Alaraj Ali, Grossberg Jonathan A, Nogueira Raul, Haussen Diogo C

机构信息

Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.

Grady Health System Marcus Stroke and Neuroscience Center, Atlanta, Georgia, USA.

出版信息

J Neurointerv Surg. 2025 Jun 1;17(e2):e295-e302. doi: 10.1136/jnis-2024-022795.

DOI:10.1136/jnis-2024-022795

PMID:39884852

Abstract

BACKGROUND

Previous studies have shown that when thrombectomy has failed, rescue intracranial stenting is associated with better clinical outcomes compared with failed reperfusion. However, comparative data regarding stent type are lacking.

OBJECTIVE

To compare the procedural and clinical outcomes of balloon-mounted stents (BMS) with those of self-expandable stents (SES).

METHODS

Retrospective analysis of a prospectively collected database from the Stenting and Angioplasty in NeuroThrombectomy (SAINT) consortium. Patients were included if thrombectomy had failed and they then underwent rescue emergency stenting. Patients treated with SES or BMS were compared using inverse probability of treatment weighting. The primary outcome was the final reperfusion as measured by the modified Thrombolysis in Cerebral Infarction (mTICI) Scale. Safety measures included rates of symptomatic intracranial hemorrhage, procedural complications, and 90-day mortality.

RESULTS

A total of 328 patients were included. Baseline clinical and procedural characteristics were well balanced among both groups. The BMS group (n=127) had higher rates of successful reperfusion (94.5% vs 86.6%, aOR=4.23, 95% CI 1.57 to 11.37, P=0.004) and increased likelihood of higher degree of final reperfusion on the mTICI Scale (acOR=2.06, 95% CI 1.19 to 3.57, P=0.01) than the SES group (n=201). No difference in modified Rankin Scale shift (acOR=0.98, 95% CI 0.54 to 1.79, P=0.95), rates of mRS0-2 (26% vs 36%, aOR=0.93, 95% CI 0.46 to 1.88, P=0.83) and mRS0-3 (43% vs 50%, aOR=0.92, 95% CI 0.51 to 1.66, P=0.77) at 90 days were noted. Safety measures were comparable in both groups.

CONCLUSION

The present study demonstrates higher reperfusion rates with BMS than with SES in failed thrombectomy procedures that involved rescue stenting. No differences in hemorrhagic complications or clinical outcomes were noted. Further larger controlled studies are warranted.

摘要

背景

既往研究表明，当血栓切除术失败时，与再灌注失败相比，挽救性颅内支架置入术的临床结局更好。然而，关于支架类型的比较数据尚缺乏。

目的

比较球囊扩张式支架（BMS）与自膨式支架（SES）的手术及临床结局。

方法

对神经血栓切除术中支架置入与血管成形术（SAINT）联盟前瞻性收集的数据库进行回顾性分析。纳入血栓切除术失败后接受挽救性紧急支架置入术的患者。采用治疗权重的逆概率对接受SES或BMS治疗的患者进行比较。主要结局为采用改良脑梗死溶栓（mTICI）量表测量的最终再灌注情况。安全指标包括症状性颅内出血发生率、手术并发症及90天死亡率。

结果

共纳入328例患者。两组间基线临床及手术特征均衡。BMS组（n = 127）的成功再灌注率（94.5% 对86.6%，校正比值比[aOR]=4.23，95%可信区间[CI]1.57至11.37，P = 0.004）及mTICI量表上最终再灌注程度更高的可能性（校正累积比值比[acOR]=2.06，95%CI 1.19至3.57，P = 0.01）高于SES组（n = 201）。90天时改良Rankin量表评分变化（acOR = 0.98，95%CI 0.54至1.79，P = 0.95）、mRS 0 - 2比例（26%对36%，aOR = 0.93，95%CI 0.46至1.88，P = 0.83）及mRS 0 - 3比例（43%对50%，aOR = 0.92，95%CI 0.51至1.66，P = 0.77）无差异。两组安全指标相当。