双支架机械取栓治疗大脑中动脉远端中血管血栓:初步经验

IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY
José Carlos Méndez, Pedro Vega, Alfonso Lopez-Frías, Teresa Díaz, Josep Puig, Eduardo Murias, Jordi Blasco, Carlos Pérez-García, Víctor Maestro, Manuel Moreu, Marc Comas-Cufí, Antonio Cruz-Culebras, María Antonia Prieto, Isabel Bermúdez-Coronel, Javier Blázquez, Jaime Masjuán
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引用次数: 0

摘要

背景与目的机械取栓术(MT)越来越多地被用于治疗急性脑卒中患者前循环远端中血管闭塞(DMVOs)。虽然试验并没有显示出MT优于常规护理,但选定的患者仍可能受益于MT。理想的血管内技术仍存在争议。我们的目的是确定双支架回收器MT (DSR-MT)治疗DMVOs的安全性和有效性。方法回顾性分析4个卒中综合中心连续接受DSR-MT治疗的急性原发性dmvo患者的人口统计学、手术特点和临床资料。再灌注由延长脑梗死溶栓(eTICI)评分定义。临床结果采用美国国立卫生研究院卒中量表(NIHSS)和改良Rankin量表(mRS)评分进行测量。结果纳入32例患者,中位年龄78岁,四分位数间距[IQR] 71 ~ 82;16例(50%)女性),其中原发性大脑中动脉M2段闭塞26例(81.2%),M3段闭塞6例(18.8%)。临床严重程度为中度(NIHSS中位数为13;24例(75%)患者IQR为10-15。20例患者(62.5%)达到首过效应(eTICI 2c/3)。30例(93.7%)患者达到最终eTICI 2b/2c/3, 25例(78.1%)患者达到最终eTICI 2c/3。1例患者出现症状性颅内出血(3.1%)。24 h时NIHSS为6 (IQR 3-12),出院时NIHSS为4 (IQR 1-9)。90天时,22例(73.3%)患者功能独立(mRS 0-2)。结论本初步研究发现DSR-MT治疗M2和M3闭塞患者DMVOs具有良好的疗效和安全性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Double Stent Retriever Mechanical Thrombectomy for Distal Medium Vessel Clots in the Middle Cerebral Artery: Initial Experience

Background and Purpose

Mechanical thrombectomy (MT) is increasingly performed for distal medium vessel occlusions (DMVOs) of the anterior circulation in acute stroke patients. Although trials have not shown superiority over usual care, selected patients may still benefit from MT. The ideal endovascular technique is debated. We aimed to determine the safety and efficacy of double stent retriever MT (DSR-MT) for DMVOs.

Methods

We retrospective analyzed demographics, procedure characteristics, and clinical data from consecutive patients with acute primary DMVOs treated with DSR-MT at four comprehensive stroke centers. Reperfusion was defined by the extended Thrombolysis In Cerebral Infarction (eTICI) score. Clinical outcomes were measured by the National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores.

Results

We included 32 patients (median age, 78 years, interquartile range [IQR] 71–82; 16 [50%] female), of whom 26 (81.2%) had primary occlusion of the M2 segment of the middle cerebral artery and six (18.8%) had occlusion of M3. Clinical severity was moderate (median, NIHSS 13; IQR 10–15) in 24 patients (75%). First-pass effect (eTICI 2c/3) was achieved in 20 patients (62.5%). Final eTICI 2b/2c/3 was achieved in 30 patients (93.7%) and final eTICI 2c/3 in 25 (78.1%). Symptomatic intracranial hemorrhage developed in one patient (3.1%). Median NIHSS was 6 at 24 h (IQR 3–12) and 4 at discharge (IQR 1–9). At 90 days, 22 (73.3%) patients were functionally independent (mRS 0–2).

Conclusions

This preliminary study found good efficacy and safety of DSR-MT for DMVOs in patients with M2 and M3 occlusions.

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来源期刊
Journal of Neuroimaging
Journal of Neuroimaging 医学-核医学
CiteScore
4.70
自引率
0.00%
发文量
117
审稿时长
6-12 weeks
期刊介绍: Start reading the Journal of Neuroimaging to learn the latest neurological imaging techniques. The peer-reviewed research is written in a practical clinical context, giving you the information you need on: MRI CT Carotid Ultrasound and TCD SPECT PET Endovascular Surgical Neuroradiology Functional MRI Xenon CT and other new and upcoming neuroscientific modalities.The Journal of Neuroimaging addresses the full spectrum of human nervous system disease, including stroke, neoplasia, degenerating and demyelinating disease, epilepsy, tumors, lesions, infectious disease, cerebral vascular arterial diseases, toxic-metabolic disease, psychoses, dementias, heredo-familial disease, and trauma.Offering original research, review articles, case reports, neuroimaging CPCs, and evaluations of instruments and technology relevant to the nervous system, the Journal of Neuroimaging focuses on useful clinical developments and applications, tested techniques and interpretations, patient care, diagnostics, and therapeutics. Start reading today!
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