单纯接触抽吸或联合支架取栓治疗大脑中动脉大血管闭塞

Contact Aspiration Alone or Combined With Stent Retriever Thrombectomy for Middle Cerebral Artery Large Vessel Occlusion.

作者信息

Navia Pedro, Fernandez-Prieto Andres, Alvarez-Muelas Alberto, Calleja Ángel, Ortega Joaquin, Domínguez Carlos, Sagredo Antonio, Rodríguez-Benítez Amado, García-Villanego Juan, Martínez-Calvo Alberto, Cubillo-Prieto Daniel, de la Rosa Carmen, Mosqueira Antonio, Bermejo-Garcés Rebeca, Chaviano Juan, Bermúdez-Coronel Isabel, Pérez-García Carlos, Rodriguez-Paz Carlos Manuel, Hidalgo-Barranco Carlos, Maynar Javier, Caniego Jose Luis, Molina-Nuevo Juan David, Maestro Víctor, Sanchís-García Juan Manuel, Balboa Oscar, Martínez-Galdamez Mario, Garmendia Eñaut, Comas-Cufí Marc, Puig Josep, Zamarro Joaquín

机构信息

Department of Diagnostic and Interventional Neuroradiology, La Paz University Hospital, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain.

Department of Radiology, Hospital Universitario Son Espases, Palma, Spain.

出版信息

J Neuroimaging. 2025 Jul-Aug;35(4):e70065. doi: 10.1111/jon.70065.

DOI:10.1111/jon.70065

PMID:40605686

Abstract

BACKGROUND AND PURPOSE

The effectiveness of a large-bore aspiration catheter for contact aspiration (CA) thrombectomy is compared to the combined use of an aspiration catheter and a stent retriever (CA+SR) for large vessel occlusion (LVO). We assessed the efficacy and safety of CA alone versus CA+SR as first-line treatment for middle cerebral artery (MCA) LVO in daily practice.

METHODS

We retrospectively analyzed data from the SARA-3 registry of patients with MCA occlusion (M1 and M2 segments), dividing them into two groups: first-line CA alone and combined CA+SR. Demographic, clinical, angiographic, and clinical outcomes (National Institute of Health Stroke Scale score at 24 h and modified Rankin Scale [mRS] score at 3 months) were compared.

RESULTS

Of 551 patients, 348 (63.8%) received CA alone and 203 (36.8%) received CA+SR. The groin-to-reperfusion time was significantly shorter in the CA-alone group than in the combined CA+SR group (median, 26 vs. 40 min, p < 0.001). The CA group demonstrated higher first-pass modified Thrombolysis In Cerebral Infarction (mTICI) 3 recanalization rates (47% vs. 37%; adjusted odds ratio [OR] 1.5 [confidence interval 1-2.1], p = 0.042), a higher final mTICI 3 rate (65% vs. 56%; OR 1.5 [1-2.2], p = 0.037), and fewer new territory embolisms (0.9% vs. 3.9%; OR 0.2 [0-0.8], p = 0.028) compared to the CA+SR group. The CA-alone group had better functional outcomes at 3 months (mRS ≤ 2, 77% vs. 63%; OR 1.9 [1.3-3], p = 0.003).

CONCLUSIONS

CA alone outperformed CA+SR as a first-line treatment for MCA LVO, yielding higher first-pass and final recanalization rates, lower new territory embolism risk, shorter procedure times, and better functional outcomes at 3 months.

摘要

背景与目的

将大口径抽吸导管用于接触性抽吸（CA）血栓切除术的有效性与抽吸导管和支架取栓器联合使用（CA+SR）治疗大血管闭塞（LVO）的有效性进行比较。我们评估了在日常实践中，单独使用CA与CA+SR作为大脑中动脉（MCA）LVO一线治疗方法的疗效和安全性。

方法

我们回顾性分析了SARA-3登记处中MCA闭塞（M1和M2段）患者的数据，将他们分为两组：一线单独使用CA组和CA+SR联合使用组。比较了人口统计学、临床、血管造影和临床结局（24小时时的美国国立卫生研究院卒中量表评分和3个月时的改良Rankin量表[mRS]评分）。

结果

551例患者中，348例（63.8%）单独接受CA治疗，203例（36.8%）接受CA+SR治疗。单独使用CA组的腹股沟至再灌注时间显著短于CA+SR联合使用组（中位数分别为26分钟和40分钟，p<0.001）。与CA+SR组相比，CA组首次通过改良脑梗死溶栓（mTICI）3级再通率更高（47%对37%；调整后的优势比[OR]为1.5[置信区间1-2.1]，p=0.042），最终mTICI 3级率更高（65%对56%；OR 1.5[1-2.2]，p=0.037），新区域栓塞更少（0.9%对3.9%；OR 0.2[0-0.8]，p=0.028）。单独使用CA组在3个月时功能结局更好（mRS≤2，77%对63%；OR 1.9[1.3-3]，p=0.003）。