用于前循环机械血栓切除术的 "桡动脉就绪 "三轴装置:技术方面和初步结果。

IF 1.2 Q4 CLINICAL NEUROLOGY
Neurointervention Pub Date : 2024-03-01 Epub Date: 2024-01-16 DOI:10.5469/neuroint.2023.00500
Stefano Molinaro, Riccardo Russo, Francesco Mistretta, Gaetano Risi, Umberto Amedeo Gava, Mauro Bergui
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引用次数: 0

摘要

目的:机械取栓术(MT)是治疗大血管闭塞(LVO)引起的急性缺血性卒中(AIS)的标准方法。经桡动脉途径(TRA)治疗前循环 LVO 的选择仍存在争议;使用特定的三轴系统有助于缓解与经桡动脉 MT 相关的诸多问题:从2022年11月到2023年11月,22例患者接受了经桡动脉MT治疗前循环LVO,既作为一线治疗,也作为经股动脉入路(TFA)失败后的抢救治疗,采用相同的三轴设置,包括7F导引鞘、7F导引导管和与闭塞部位相关的5.5F至5F抽吸导管。血栓切除技术由操作者自行决定。报告了患者的人口统计学数据、临床表现、治疗细节、并发症、TFA交叉率、血管再通成功率(改良脑梗死溶栓评分≥2b)以及3个月后的良好临床结果(改良Rankin量表[mRS] 0-2):在选取的 20 例患者中,10 例(50%)为大脑中动脉(MCA)M1 段闭塞,6 例(30%)为颈内动脉(ICA)末端闭塞,4 例(20%)为 M2 MCA 闭塞;12/20(60%)为右侧闭塞,8/20(40%)为左侧闭塞。入院时美国国立卫生研究院卒中量表平均评分为 9.25 分。18/20(90%)名患者的血管再通成功率达到 mTICI 2b-3。2例(10%)患者出现颅内并发症。24小时内桡动脉闭塞率为10.6%;未报告入路部位出血并发症。2例(10%)患者出现了症状性颅内出血,3个月时mRS评分为0-2分的患者占50%:结论:这种用于AIS TRA-MT的特殊三轴设置技术有效性高、安全性好,即使是大的近端LVO,在某些情况下也能成为TFA-MT的可行替代方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A "Radial Ready" Tricoaxial Setup for Anterior Circulation Mechanical Thrombectomy: Technical Aspects and Preliminary Results.

Purpose: Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). The choice of a transradial approach (TRA) for anterior circulation LVOs is still debatable; the use of a specific tricoaxial system could help mitigate numerous issues related to transradial MT.

Materials and methods: From November 2022 to November 2023, 22 patients underwent TRA-MT for anterior circulation LVOs, both as first-line and rescue from transfemoral approach (TFA) failure, with the same triaxial setup consisting of a 7F introducer sheath, 7F guide catheter, and aspiration catheters ranging from 5.5F to 5F in relation to the occlusion site. Choice of thrombectomy technique was at operator discretion. Patients' demographic data, clinical presentation, treatment details, complications, rate of crossover to TFA, successful revascularization (modified thrombolysis in cerebral infarction [mTICI] score ≥2b), and good clinical outcome at 3 months (modified Rankin scale [mRS] 0-2) were reported.

Results: Of 20 patients selected, 10 (50%) had occlusion of M1 segment of middle cerebral artery (MCA), 6 (30%) of internal carotid artery (ICA) terminus, and 4 (20%) with M2 MCA occlusions; 12/20 (60%) were right-sided occlusions and 8/20 (40%) were left-sided. The mean National Institutes of Health Stroke Scale score was 9.25 at admission. Successful revascularization to mTICI 2b-3 was achieved in 18/20 patients (90%). Intracranial complications were reported in 2 (10%) patients. Rate of radial artery occlusion at 24 hours was 10,6%; no access-site haemorrhagic complications were reported. Symptomatic intracranial hemorrhage occurred in 2 (10%) patients. mRS score 0-2 at 3 months was 50%.

Conclusion: The high technical effectiveness and good safety profile of this specific tricoaxial setup for TRA-MT in AIS, even for large proximal LVOs, could constitute a viable alternative to TFA-MT in selected cases.

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CiteScore
1.80
自引率
0.00%
发文量
34
审稿时长
12 weeks
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