机械取栓治疗远端中血管闭塞的安全性和有效性：来自意大利卒中中心的经验和真实数据

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-04-14 DOI:10.1016/j.jstrokecerebrovasdis.2025.108321

Michele Alessiani , Adriano Bonura , Gianmarco Iaccarino , Sergio Soeren Rossi , Marilena Mangiardi , Maria Cristina Bravi , Francesca Romana Pezzella , Gianluca de Rubeis , Enrico Pampana , Sabrina Anticoli

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引用次数: 0

摘要

背景和目的近25- 40%的缺血性卒中病例是由远中血管闭塞（DMVOs）引起的。静脉溶栓（IVT）在50%的病例中实现了完全的再通。观察性研究已经证明机械取栓（MT）在DMVOs中的疗效和安全性与LVOs相当。最近发表的随机对照试验显示，与单用最佳药物治疗相比，MT加最佳药物治疗并不能改善DMVO患者的预后。方法我们根据文献分类对急性缺血性卒中（AIS）和原发性或继发性DMVO患者进行回顾性观察研究。DMVOs定义为A2、A3、M2远端或其单个分支、M3、P2、P3、PICA、SCA和AICA的闭塞。主要终点是评估单独MT与IVT治疗DMVOs的安全性和有效性。采用入院至出院时NIHSS变化、3个月修正Rankin量表（mRS）、3个月死亡率和再通率评价疗效。安全性评估基于出血转化和手术并发症。作为次要终点，我们比较原发性和继发性DMVO以突出任何差异。结果经倾向评分分析，MT组与IVT组在原发性和继发性DMVO的疗效和安全性方面差异无统计学意义，但MT组NIHSS有下降的趋势。原发性DMVO的亚分析在两组之间没有显着差异。MT组再通率极佳，95%病例mTICI≥2b，无手术并发症发生。结论smt在DMVOs中的再通率高，手术并发症少。需要新的随机对照试验来分别比较MT单独与IVT单独治疗原发性和继发性DMVOs的疗效和安全性。

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Safety and efficacy of mechanical thrombectomy in distal medium vessel occlusions: Experience and real-world data from an Italian stroke hub centre

Background and Purpose

Distal-medium vessel occlusions (DMVOs) contribute to approximately 25-40 % of cases of ischemic stroke. Intravenous thrombolysis (IVT) achieved a complete recanalization in <50 % of cases. Observational studies have demonstrated comparable efficacy and safety of mechanical thrombectomy (MT) in DMVOs compared to LVOs. Recently published RCTs have shown that MT plus best medical therapy in DMVOs does not improve the outcome compared to best medical therapy alone

Methods

We conducted a retrospective observational study involving patients with acute ischemic stroke (AIS) and primary or secondary DMVO according to literature classification. DMVOs were defined as occlusion in the A2, A3, distal M2 or its single branch, M3, P2, P3, PICA, SCA and AICA. The primary endpoint was to evaluate the safety and efficacy of MT alone in DMVOs compared to IVT. Efficacy was assessed by considering the change in NIHSS from admission to discharge, 3 months Modified Rankin Scale (mRS), 3 months mortality rate and recanalization rate. Safety was assessed based on haemorrhagic transformation and procedural complications. As a secondary endpoint we compared primary and secondary DMVO to highlight any differences.

Results

In primary plus secondary DMVO after propensity score analysis there were no statistically significant differences in efficacy and safety between MT and IVT though a positive trend for NIHSS reduction in the MT group. Sub-analysis of primary DMVO did not show significant differences between the two groups. MT group achieved an excellent recanalization rate with mTICI ≥2b in 95 % of cases and no procedural complications occurred.

Conclusions

MT in DMVOs showed an excellent recanalization rate and few procedural complications. New RCTs are needed to compare the efficacy and safety of MT alone versus IVT alone in primary and secondary DMVOs separately.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.