Predictors of Emboli in Mechanical Thrombectomy for Anterior Circulation Stroke.

Yongho Kwon, Ho Jun Yi, Dong-Seong Shin, Bum-Tae Kim
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Abstract

Objective: Emboli commonly occurs in mechanical thrombectomy (MT). The objective of this study was to analyze predicting factors of emboli after MT.

Methods: Patients who underwent MT with successful reperfusion for anterior circulation occlusion were enrolled. Emboli included distal emboli at digital subtraction angiography (DSA) and unexpected embolic infarct on diffusion-weighted image (DWI) without distal emboli at DSA. Baseline characteristics, procedural details, angiographic outcomes, and clinical outcomes were reviewed. Multivariable analyses were performed to evaluate predictive factors for the occurrence of emboli.

Results: Of 601 patients, 149 (24.8%) patients had distal emboli at DSA, and 169 (28.1%) patients had unexpected embolic infarction on DWI even without distal emboli at DSA. A total of 318 (52.9%) patients were enrolled in the embolic group, and 283 (47.1%) patients were assigned to the non-embolic group. In multivariate analysis, larger microcatheter (OR 1.26, 95% CI 1.12-1.94; p = 0.047), clot passage (OR 1.33, 95% CI 1.07-1.87; p = 0.041), use of balloon guide catheter (BGC) (OR 0.70, 95% CI 0.52-0.92; p = 0.014), early ballooning of BGC (OR 0.68, 95% CI 0.50-0.90; p = 0.009), and longer stent retriever (OR 0.72, 95% CI 0.54-0.90; p = 0.029) were associated with occurrence of emboli.

Conclusion: MT with only a stent retriever, use of a larger microcatheter, and clot passage might increase the risk of emboli. In contrast, contact aspiration thrombectomy, use of BGC, early ballooning of BGC, and use of longer stent retrievers could reduce the chance of emboli.

前循环中风机械取栓术中栓塞的预测因素
目的:栓塞通常发生在机械血栓切除术(MT)中。本研究旨在分析 MT 术后栓塞的预测因素:方法:纳入因前循环闭塞接受机械取栓术并成功再灌注的患者。栓子包括数字减影血管造影(DSA)中的远端栓子和弥散加权成像(DWI)中无远端栓子的意外栓塞。对基线特征、手术细节、血管造影结果和临床结果进行了回顾。进行了多变量分析,以评估发生栓塞的预测因素:结果:在601名患者中,149名(24.8%)患者在DSA检查中发现远端栓子,169名(28.1%)患者即使在DSA检查中没有发现远端栓子,但在DWI检查中也出现了意外的栓塞梗死。共有 318 名(52.9%)患者被纳入栓塞组,283 名(47.1%)患者被纳入非栓塞组。92;P = 0.014)、BGC 早期球囊化(OR 0.68,95% CI 0.50-0.90;P = 0.009)和较长的支架回缩器(OR 0.72,95% CI 0.54-0.90;P = 0.029)与栓子的发生有关:结论:仅使用支架牵引器的 MT、使用较大的微导管和血栓通过可能会增加栓塞风险。相比之下,接触式抽吸血栓切除术、使用 BGC、BGC 早期球囊化以及使用较长的支架回取器可以降低栓塞发生的几率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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