Bhogal Pervinder, Mancuso-Marcello Marco, Fairhead Rory, Parkin Katherine, Klefti Giovanna, Makalanda Levansri, Wong Ken, Lansley Joseph, Vanchilingham Karthikeyan, Przyszlak Michael, Saqib Rukhtam, Spooner Oliver
Department of Interventional Neuroradiology, The Royal London Hospital, Whitechapel Road, London, UK.
Department of Stroke, The Royal London Hospital, Whitechapel Road, London, UK.
Interv Neuroradiol. 2025 May 21:15910199251337176. doi: 10.1177/15910199251337176.
Stent-retriever-based mechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). First-pass effect (FPE) is one most powerful predictors of positive outcomes in LVO AIS patients treated with MT. We performed an independent central reader review of our prospectively maintained database to identify all patients treated first with the NeVa stent retriever at our single high-volume Comprehensive Stroke Centre.Overall, 89 patients met our inclusion criteria. The median age was 73 yrs (range 28-88; 52% male). The median presentation NIHSS was 16 (range 5-30) and 49% received IV tPA prior to MT. 93% of target occlusions were in the anterior circulation ( = 83) with a median ASPECT score on plain CT of 8 (range 5-10). A Balloon Guide Catheter (BGC) was used in 80% of cases and a distal aspiration catheter was used in all cases. Longer NeVa models (≥29 mm) were used in 89% of cases. FPE was demonstrated in 57% of cases (eTICI score of ≥2c) with modified FPE demonstrated in 65.1% of cases (eTICI score of ≥2b (67%)). A final eTICI score of ≥2c was achieved in 87% of cases. Good functional outcome (mRS ≤2) was achieved in 40% of patients ( = 81).The NeVa stent-retriever has a very high rate of FPE and final recanalization in this real-world cohort of patients from the NeVa One registry. These results are higher than those previously published and may support longer NeVa device use with a BGC and proximal aspiration to optimize FPE.
基于支架取栓器的机械取栓术（MT）是治疗由大血管闭塞（LVO）引起的急性缺血性卒中（AIS）的一种有效方法。首次通过效应（FPE）是接受MT治疗的LVO AIS患者获得良好预后的最强有力预测指标之一。我们对前瞻性维护的数据库进行了独立的中心阅片审查，以确定在我们单一的高容量综合卒中中心首先使用NeVa支架取栓器治疗的所有患者。
总体而言，89例患者符合我们的纳入标准。中位年龄为73岁（范围28 - 88岁；52%为男性）。中位就诊时美国国立卫生研究院卒中量表（NIHSS）评分为16分（范围5 - 30分），49%的患者在MT之前接受了静脉注射组织型纤溶酶原激活剂（IV tPA）。93%的目标闭塞位于前循环（n = 83），平扫CT上的中位脑缺血半暗带早期CT评分（ASPECT）为8分（范围5 - 10分）。80%的病例使用了球囊导引导管（BGC），所有病例均使用了远端抽吸导管。89%的病例使用了更长的NeVa型号（≥29 mm）。57%的病例显示有FPE（脑梗死溶栓分级（eTICI）评分≥2c），65.1%的病例显示有改良FPE（eTICI评分≥2b（67%））。87%的病例最终eTICI评分≥2c。40%的患者（n = 81）获得了良好的功能预后（改良Rankin量表（mRS）≤2）。
在来自NeVa One注册研究的这一真实世界患者队列中，NeVa支架取栓器具有非常高的FPE率和最终再通率。这些结果高于先前发表的结果，可能支持更长的NeVa器械与BGC及近端抽吸联合使用以优化FPE。
