Safety first: A comparative study of mechanical thrombectomy techniques for M2 occlusions – stent-retriever thrombectomy (SRT) vs. first stenting without retrieval (FRESH)

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-05-12 DOI:10.1016/j.clineuro.2025.108956

Jonghoon Kim

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引用次数: 0

Abstract

Background

The most appropriate method for mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) due to M2 segment middle cerebral artery (MCA) occlusion remains unclear. Hence, this study aimed to investigate the benefits of first stenting without retrieval (FRESH) vs. stent-retriever thrombectomy (SRT) for treating patients with M2 occlusion–associated AIS.

Methods

The data of patients who underwent MT for AIS at our institution between January 2019 and December 2023 were reviewed. Treatment variables, clinical outcomes, and complications were analyzed.

Results

Thirty-five patients with M2 MCA occlusion of the anterior circulation were included. Among these patients, 20 (57.1 %) underwent SRT, whereas 15 (42.9 %) underwent FRESH. The puncture-to-recanalization time was significantly shorter in the FRESH group (35 vs. 41.5 min, p < 0.001). Asymptomatic intracranial hemorrhage was significantly more common in the SRT group than in the FRESH group (18.8 % vs. 0 %, p = 0.027). The FRESH group was more likely to experience both favorable clinical outcomes (modified Rankin score [mRS]: 0–2; 86.7 % vs. 55 %, respectively, p = 0.069) and excellent clinical outcomes (mRS: 0–1; 66.7 % vs. 25 %, p = 0.014).

Conclusion

The FRESH technique is a more efficient method for minimizing procedural risk while achieving recanalization in the treatment of patients with acute M2 occlusions.

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安全第一：机械取栓技术治疗M2闭塞的比较研究——支架取栓（SRT）与首次支架取栓（FRESH）

背景：由于大脑中动脉（MCA） M2段闭塞导致的急性缺血性卒中（AIS）患者机械取栓（MT）的最合适方法尚不清楚。因此，本研究旨在探讨首次支架置入术（FRESH）与支架置入术取栓（SRT）治疗M2闭塞相关AIS患者的益处。方法回顾2019年1月至2023年12月在我院接受AIS MT治疗的患者资料。分析治疗变量、临床结果和并发症。结果本组共纳入35例前循环M2型MCA闭塞患者。在这些患者中，20例（57.1% %）接受了SRT，而15例（42.9% %）接受了FRESH。FRESH组穿刺至再通时间明显缩短（35 vs 41.5 min, p <； 0.001）。SRT组无症状颅内出血发生率明显高于FRESH组（18.8 % vs. 0 %,p = 0.027）。FRESH组更有可能获得两种有利的临床结果(修正Rankin评分[mRS]: 0-2；分别为86.7 %对55 %，p = 0.069)和优异的临床结果(mRS: 0-1；66.7 % vs. 25 %,p = 0.014)。结论FRESH技术是治疗急性M2闭塞患者在实现再通的同时降低手术风险的一种更有效的方法。

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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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.