导航远端血管:失败的取栓试验的挑战和教训。

IF 2.1 4区 医学 Q4 CLINICAL NEUROLOGY
Peter B Sporns, Mohammad Almohammad, Jens Minnerup, Thi Dan Linh Nguyen-Kim, Jens Fiehler, Lars Timmermann, André Kemmling
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引用次数: 0

摘要

虽然血管内血栓切除术(EVT)在大血管闭塞性卒中中的应用已经确立,但最近将EVT扩展到远端中血管闭塞(DMVOs)的热情已被三个主要随机对照试验(远端、ESCAPE-MeVO和DISCOUNT)的中性结果所缓和。目的:批判性地研究EVT在DMVO试验中未能证明其益处的原因,评估相关的程序和临床挑战,并探索安全有效的远端脑血管区域治疗的潜在未来方向。方法:本综述综合了最近DMVO取栓试验的主要发现,并将其置于远端介入的解剖学、技术和临床局限性背景下。它进一步强调了设备和远端EVT技术的创新作为可能的解决方案。研究结果:对于未选择的DMVO患者,试验显示EVT在功能上没有优于最佳药物治疗,并引起了安全性问题,包括EVT组症状性颅内出血和死亡率的部分增加。影响因素包括远端血管的易碎性和弯曲性、设备兼容性欠佳、操作人员经验的差异以及成像和患者选择的潜在限制。初步数据表明,改进的技术可以减轻非常远端闭塞的风险。结论根据目前的证据,不能推荐常规EVT治疗DMVO脑卒中。未来的研究必须优先考虑患者分层、专用远端设备和程序创新,以安全地将血栓切除术扩展到远端区域。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Navigating the distal vasculature: Challenges and lessons learned from failed Thrombectomy trials.

BackgroundWhile endovascular thrombectomy (EVT) is firmly established for large vessel occlusion stroke, recent enthusiasm for extending EVT to distal medium vessel occlusions (DMVOs) has been tempered by the neutral results of three major randomized controlled trials: DISTAL, ESCAPE-MeVO, and DISCOUNT.ObjectiveTo critically examine why EVT failed to demonstrate benefit in DMVO trials, assess the associated procedural and clinical challenges, and explore potential future directions for safe and effective treatment in distal cerebrovascular territories.MethodsThis review synthesizes the key findings of recent DMVO thrombectomy trials and contextualizes them within the anatomical, technical, and clinical limitations specific to distal interventions. It further highlights innovations of devices and distal EVT techniques as possible solutions.FindingsThe trials showed no functional benefit of EVT over best medical therapy for unselected DMVO patients and raised safety concerns, including partially increased rates of symptomatic intracranial hemorrhage and mortality in the EVT arms. Contributing factors include the fragility and tortuosity of distal vessels, suboptimal device compatibility, variability in operator experience, and potential limitations in imaging and patient selection. Preliminary data suggest that refined techniques may mitigate risks in very distal occlusions.ConclusionsRoutine EVT for DMVO stroke cannot be recommended based on current evidence. Future research must prioritize patient stratification, dedicated distal devices, and procedural innovation to safely extend thrombectomy into distal territories.

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来源期刊
Interventional Neuroradiology
Interventional Neuroradiology CLINICAL NEUROLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
CiteScore
3.60
自引率
11.80%
发文量
192
审稿时长
6-12 weeks
期刊介绍: Interventional Neuroradiology (INR) is a peer-reviewed clinical practice journal documenting the current state of interventional neuroradiology worldwide. INR publishes original clinical observations, descriptions of new techniques or procedures, case reports, and articles on the ethical and social aspects of related health care. Original research published in INR is related to the practice of interventional neuroradiology...
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