Thrombectomy for medium-sized cerebral vessel occlusion: Size does matter.

IF 4.5 3区 医学 Q1 CLINICAL NEUROLOGY
Pekka Virtanen, Silja Räty, Liisa Tomppo, Nina Brandstack, Erno Peltola, Tatu Kokkonen, Mikko Sillanpää, Daniel Strbian
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Abstract

Introduction: Randomised controlled trials comparing endovascular thrombectomy (EVT) to medical treatment in patients with medium vessel occlusion (MeVO) suggested neutrality or futility of EVT. We studied whether the size difference between thrombectomy device and the occluded vessel influenced MeVO outcomes.

Patients and methods: This was a retrospective single-centre observational study comprising EVT-treated patients with occlusion of the M2 branch of the middle cerebral artery on digital subtraction angiography. The diameter of the occluded M2 was measured and compared to the manufacturer's recommendation for the minimal vessel size. Based on this device-to-vessel size ratio, we divided the patients into three groups: A) ratio ⩽1.0 (device smaller or equals the vessel size), B) 1.0 < ratio ⩽ 1.2 (device larger, difference ⩽20%), and C) ratio >1.2 (device larger, significant difference >20%). The primary outcomes were futility (3-month modified Rankin scale 5 or 6) and symptomatic intracranial haemorrhage (sICH).

Results: In the cohort of 146 patients (median age 73; 47.3% women), 58.9% were in group A, 13.7% in group B and 27.4% in group C. Patients in group C had more frequently sICH (20.0%) compared to group A (7.0%) and group B (5.0%), and the highest futility rate (34.2% vs 17.3% vs 25.0%, respectively). In the adjusted analyses, belonging to the group C was associated with sICH (OR 3.32 [1.04-10.64]) and mRS 5-6 (OR 2.84 [1.09-7.37]).

Discussion and conclusions: The size of the thrombectomy device relative to the size of the occluded vessel is associated with haemorrhagic complications and futile outcomes.

中型脑血管闭塞的取栓:大小很重要。
简介:随机对照试验比较了血管内血栓切除术(EVT)与药物治疗对中度血管闭塞(MeVO)患者的影响,结果表明EVT无效。我们研究取栓装置和闭塞血管的大小差异是否会影响MeVO结果。患者和方法:这是一项回顾性的单中心观察性研究,包括在数字减影血管造影中接受evt治疗的大脑中动脉M2支闭塞的患者。测量闭塞的M2直径,并与制造商推荐的最小血管尺寸进行比较。基于该器械与血管的尺寸比,我们将患者分为三组:A) ratio≥1.0(器械小于或等于血管尺寸),B) 1.0 < ratio≥1.2(器械较大,差异≥20%),C) ratio >1.2(器械较大,差异显著>≥20%)。主要结果为无效(3个月改良Rankin量表5或6)和症状性颅内出血(sICH)。结果:146例患者(中位年龄73岁,女性占47.3%)中,A组为58.9%,B组为13.7%,C组为27.4%。C组患者sICH发生率(20.0%)高于A组(7.0%)和B组(5.0%),不孕率最高(分别为34.2%比17.3%和25.0%)。在校正分析中,属于C组与sICH (OR 3.32[1.04-10.64])和mRS 5-6 (OR 2.84[1.09-7.37])相关。讨论和结论:取栓装置的大小相对于闭塞血管的大小与出血并发症和无效结果有关。
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
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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