双支架取栓器用于大脑中动脉远端中等血管血栓的机械取栓术：初步经验

Double Stent Retriever Mechanical Thrombectomy for Distal Medium Vessel Clots in the Middle Cerebral Artery: Initial Experience.

作者信息

Méndez José Carlos, Vega Pedro, Lopez-Frías Alfonso, Díaz Teresa, Puig Josep, Murias Eduardo, Blasco Jordi, Pérez-García Carlos, Maestro Víctor, Moreu Manuel, Comas-Cufí Marc, Cruz-Culebras Antonio, Prieto María Antonia, Bermúdez-Coronel Isabel, Blázquez Javier, Masjuán Jaime

机构信息

Interventional Neuroradiology, Hospital Universitario Ramón y Cajal, Madrid, Spain.

Radiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.

出版信息

J Neuroimaging. 2025 Jul-Aug;35(4):e70064. doi: 10.1111/jon.70064.

DOI:10.1111/jon.70064

PMID:40685504

Abstract

BACKGROUND AND PURPOSE

Mechanical thrombectomy (MT) is increasingly performed for distal medium vessel occlusions (DMVOs) of the anterior circulation in acute stroke patients. Although trials have not shown superiority over usual care, selected patients may still benefit from MT. The ideal endovascular technique is debated. We aimed to determine the safety and efficacy of double stent retriever MT (DSR-MT) for DMVOs.

METHODS

We retrospective analyzed demographics, procedure characteristics, and clinical data from consecutive patients with acute primary DMVOs treated with DSR-MT at four comprehensive stroke centers. Reperfusion was defined by the extended Thrombolysis In Cerebral Infarction (eTICI) score. Clinical outcomes were measured by the National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores.

RESULTS

We included 32 patients (median age, 78 years, interquartile range [IQR] 71-82; 16 [50%] female), of whom 26 (81.2%) had primary occlusion of the M2 segment of the middle cerebral artery and six (18.8%) had occlusion of M3. Clinical severity was moderate (median, NIHSS 13; IQR 10-15) in 24 patients (75%). First-pass effect (eTICI 2c/3) was achieved in 20 patients (62.5%). Final eTICI 2b/2c/3 was achieved in 30 patients (93.7%) and final eTICI 2c/3 in 25 (78.1%). Symptomatic intracranial hemorrhage developed in one patient (3.1%). Median NIHSS was 6 at 24 h (IQR 3-12) and 4 at discharge (IQR 1-9). At 90 days, 22 (73.3%) patients were functionally independent (mRS 0-2).

CONCLUSIONS

This preliminary study found good efficacy and safety of DSR-MT for DMVOs in patients with M2 and M3 occlusions.

摘要

背景与目的

对于急性脑卒中患者前循环的远端中等血管闭塞（DMVO），机械取栓术（MT）的应用越来越多。尽管试验未显示其优于常规治疗，但部分患者仍可能从MT中获益。理想的血管内技术仍存在争议。我们旨在确定双支架取栓MT（DSR-MT）治疗DMVO的安全性和有效性。

方法

我们回顾性分析了在四个综合卒中中心接受DSR-MT治疗的连续性急性原发性DMVO患者的人口统计学资料、手术特征和临床数据。再灌注由扩展的脑梗死溶栓（eTICI）评分定义。临床结局通过美国国立卫生研究院卒中量表（NIHSS）和改良Rankin量表（mRS）评分来衡量。

结果

我们纳入了32例患者（中位年龄78岁，四分位间距[IQR]71 - 82；16例[50%]为女性），其中26例（81.2%）为大脑中动脉M2段原发性闭塞，6例（18.8%）为M3段闭塞。24例患者（75%）临床严重程度为中度（中位NIHSS 13；IQR 10 - 15）。20例患者（62.5%）实现了首次通过效应（eTICI 2c/3）。30例患者（93.7%）实现了最终eTICI 2b/2c/3，25例（78.1%）实现了最终eTICI 2c/3。1例患者（3.1%）发生了有症状的颅内出血。24小时时NIHSS中位值为6（IQR 3 - 12），出院时为4（IQR 1 - 9）。90天时，22例（73.3%）患者功能独立（mRS 0 - 2）。