Mahmoud H Mohammaden, Pedro N Martins, Hassan Aboul-Nour, Alhamza R Al-Bayati, Ameer E Hassan, Wondwossen Tekle, Johanna T Fifi, Shahram Majidi, Okkes Kuybu, Bradley A Gross, Michael Lang, Gustavo M Cortez, Ricardo A Hanel, Amin Aghaebrahim, Eric Sauvageau, Mohamed A Tarek, Mudassir Farooqui, Santiago Ortega-Gutierrez, Cynthia B Zevallos, Milagros Galecio-Castillo, Sunil A Sheth, Michael Nahhas, Sergio Salazar-Marioni, Thanh N Nguyen, Mohamad Abdalkader, Piers Klein, Muhammad Hafeez, Peter Kan, Omar Tanweer, Ahmad Khaldi, Hanzhou Li, Mouhammad Jumaa, Syed F Zaidi, Marion Oliver, Mohamed M Salem, Jan-Karl Burkhardt, Bryan Pukenas, Nicholas Vigilante, Mary Penckofer, James E Siegler, Sophia Peng, Ali Alaraj, Jonathan A Grossberg, Raul Nogueira, Diogo C Haussen
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引用次数: 0
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.
背景：既往研究表明，当取栓失败时，抢救性颅内支架置入术与再灌注失败相比具有更好的临床结果。然而，缺乏关于支架类型的比较数据。目的：比较球囊支架（BMS）与自扩支架（SES）的手术和临床效果。方法：回顾性分析前瞻性收集的神经血栓切除术（SAINT）支架置入术和血管成形术数据库。如果取栓失败，则纳入患者，然后进行紧急支架置入术。采用治疗加权逆概率对SES或BMS治疗的患者进行比较。主要终点是通过改良的脑梗死溶栓（mTICI）量表测量的最终再灌注。安全性措施包括症状性颅内出血、手术并发症和90天死亡率。结果：共纳入328例患者。两组的基线临床和手术特征平衡良好。BMS组（n=127）比SES组（n=201）具有更高的再灌注成功率（94.5% vs 86.6%, aOR=4.23, 95% CI 1.57 ~ 11.37， P=0.004）和mTICI量表较高的最终再灌注程度的可能性（acOR=2.06, 95% CI 1.19 ~ 3.57， P=0.01）。在改良的Rankin量表移位（acOR=0.98, 95% CI 0.54至1.79，P=0.95）， mRS0-2（26%对36%，aOR=0.93, 95% CI 0.46至1.88，P=0.83）和mRS0-3（43%对50%，aOR=0.92, 95% CI 0.51至1.66，P=0.77）在90天无差异。两组的安全措施具有可比性。结论：目前的研究表明，在涉及抢救支架置入术的失败取栓手术中，BMS的再灌注率高于SES。出血性并发症和临床结果均无差异。进一步更大规模的对照研究是有必要的。
期刊介绍：
The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.
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