Kunakorn Atchaneeyasakul, Amer M Malik, Dileep R Yavagal, Diogo C Haussen, Ashutosh P Jadhav, Mehdi Bouslama, Cynthia L Kenmuir, Shashvat Desai, Jonathan A Grossberg, Seemant Chaturvedi, Tudor G Jovin, Raul G Nogueira
{"title":"脑中动脉M2闭塞引起的急性缺血性脑卒中，支架取出器与抽吸器的血栓切除术结果:一项多中心的经验。","authors":"Kunakorn Atchaneeyasakul, Amer M Malik, Dileep R Yavagal, Diogo C Haussen, Ashutosh P Jadhav, Mehdi Bouslama, Cynthia L Kenmuir, Shashvat Desai, Jonathan A Grossberg, Seemant Chaturvedi, Tudor G Jovin, Raul G Nogueira","doi":"10.1159/000500198","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To examine outcomes for thrombectomy devices used for treatment of acute ischemic stroke (AIS) with middle cerebral artery (MCA) M2 segment emergent large vessel occlusion (ELVO) as the optimal device for such reperfusion is not clearly defined.</p><p><strong>Methods: </strong>A retrospective cohort study of consecutive AIS patients with MCA M2 ELVO undergoing thrombectomy from 3 academic medical centers was conducted from October 1999 through June 2016. The patients were divided based on the device utilized. Multivariate analysis of associations between devices (stent retriever or aspiration only [manual or pump aspiration system]) was performed. Primary outcomes were good recanalization (i.e., modified thrombolysis in cerebral infarction score ≥2b) and a favorable modified Rankin scale (mRS) score (i.e. ≤2). The secondary outcome was symptomatic intracerebral hemorrhage (sICH).</p><p><strong>Results: </strong>A total of 197 AIS patients underwent MCA M2 ELVO thrombectomy with either a stent retriever (<i>n</i> = 120) or aspiration only (<i>n</i> = 77). The aspiration-only group utilized either manual (<i>n</i> = 38) or pump aspiration (<i>n</i> = 39). Utilization of a stent retriever over manual aspiration is independently associated with higher odds of a favorable mRS score (OR = 3.2; 95% CI 1.02-9.7) and lower odds of sICH (OR = 0.09; 95% CI 0.03-0.31). Utilization of a stent retriever over a pump aspiration system is independently associated with higher odds of good recanalization (OR = 3.8; 95% CI 1.5-9.6). Utilization of a newer-generation pump aspiration catheter compared to a stent retriever resulted in similar rates of favorable mRS scores, sICH, successful recanalization, and mortality.</p><p><strong>Conclusion: </strong>Utilization of a newer-generation pump aspiration catheter compared to a stent retriever resulted in similar outcomes, but worse outcomes were seen with the manual aspiration technique. These findings need to be confirmed with a large randomized trial utilizing stent retrievers and newer-generation pump aspiration systems.</p>","PeriodicalId":46280,"journal":{"name":"Interventional Neurology","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000500198","citationCount":"19","resultStr":"{\"title\":\"Thrombectomy Outcomes in Acute Ischemic Stroke due to Middle Cerebral Artery M2 Occlusion with Stent Retriever versus Aspiration: A Multicenter Experience.\",\"authors\":\"Kunakorn Atchaneeyasakul, Amer M Malik, Dileep R Yavagal, Diogo C Haussen, Ashutosh P Jadhav, Mehdi Bouslama, Cynthia L Kenmuir, Shashvat Desai, Jonathan A Grossberg, Seemant Chaturvedi, Tudor G Jovin, Raul G Nogueira\",\"doi\":\"10.1159/000500198\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To examine outcomes for thrombectomy devices used for treatment of acute ischemic stroke (AIS) with middle cerebral artery (MCA) M2 segment emergent large vessel occlusion (ELVO) as the optimal device for such reperfusion is not clearly defined.</p><p><strong>Methods: </strong>A retrospective cohort study of consecutive AIS patients with MCA M2 ELVO undergoing thrombectomy from 3 academic medical centers was conducted from October 1999 through June 2016. The patients were divided based on the device utilized. Multivariate analysis of associations between devices (stent retriever or aspiration only [manual or pump aspiration system]) was performed. Primary outcomes were good recanalization (i.e., modified thrombolysis in cerebral infarction score ≥2b) and a favorable modified Rankin scale (mRS) score (i.e. ≤2). The secondary outcome was symptomatic intracerebral hemorrhage (sICH).</p><p><strong>Results: </strong>A total of 197 AIS patients underwent MCA M2 ELVO thrombectomy with either a stent retriever (<i>n</i> = 120) or aspiration only (<i>n</i> = 77). The aspiration-only group utilized either manual (<i>n</i> = 38) or pump aspiration (<i>n</i> = 39). Utilization of a stent retriever over manual aspiration is independently associated with higher odds of a favorable mRS score (OR = 3.2; 95% CI 1.02-9.7) and lower odds of sICH (OR = 0.09; 95% CI 0.03-0.31). Utilization of a stent retriever over a pump aspiration system is independently associated with higher odds of good recanalization (OR = 3.8; 95% CI 1.5-9.6). Utilization of a newer-generation pump aspiration catheter compared to a stent retriever resulted in similar rates of favorable mRS scores, sICH, successful recanalization, and mortality.</p><p><strong>Conclusion: </strong>Utilization of a newer-generation pump aspiration catheter compared to a stent retriever resulted in similar outcomes, but worse outcomes were seen with the manual aspiration technique. These findings need to be confirmed with a large randomized trial utilizing stent retrievers and newer-generation pump aspiration systems.</p>\",\"PeriodicalId\":46280,\"journal\":{\"name\":\"Interventional Neurology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2020-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1159/000500198\",\"citationCount\":\"19\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Interventional Neurology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1159/000500198\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2019/6/18 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Interventional Neurology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1159/000500198","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2019/6/18 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 19
摘要
目的:在大脑中动脉(MCA) M2段突发大血管闭塞(ELVO)的急性缺血性卒中(AIS)患者再灌注最佳装置尚未明确的情况下，探讨取栓装置的治疗效果。方法:对1999年10月至2016年6月在3个学术医疗中心连续行MCA M2 ELVO取栓术的AIS患者进行回顾性队列研究。根据使用的器械对患者进行分组。对不同器械(支架回收器或单纯抽吸[手动或泵抽吸系统])之间的相关性进行多变量分析。主要结果为良好的再通(即改良的脑梗死溶栓评分≥2b)和良好的改良Rankin量表(mRS)评分(即≤2)。次要结局为症状性脑出血(siich)。结果:共有197例AIS患者接受了MCA M2 ELVO取栓术，支架取栓器(n = 120)或单纯抽吸(n = 77)。单纯抽吸组采用手动(n = 38)或泵抽吸(n = 39)。使用支架取物器而不是手工抽吸与较高的有利mRS评分几率独立相关(OR = 3.2;95% CI 1.02-9.7)和较低的sICH几率(OR = 0.09;95% ci 0.03-0.31)。与泵吸系统相比，支架回收器的使用与良好再通的可能性更高独立相关(OR = 3.8;95% ci 1.5-9.6)。与支架回收器相比，新一代泵吸导管的使用导致了相似的有利的mRS评分，siich，成功的再通和死亡率。结论:与支架回收器相比，使用新一代泵吸导管可获得相似的结果，但人工吸吸技术的结果更差。这些发现需要通过使用支架回收器和新一代泵吸入系统的大型随机试验来证实。
Thrombectomy Outcomes in Acute Ischemic Stroke due to Middle Cerebral Artery M2 Occlusion with Stent Retriever versus Aspiration: A Multicenter Experience.
Objective: To examine outcomes for thrombectomy devices used for treatment of acute ischemic stroke (AIS) with middle cerebral artery (MCA) M2 segment emergent large vessel occlusion (ELVO) as the optimal device for such reperfusion is not clearly defined.
Methods: A retrospective cohort study of consecutive AIS patients with MCA M2 ELVO undergoing thrombectomy from 3 academic medical centers was conducted from October 1999 through June 2016. The patients were divided based on the device utilized. Multivariate analysis of associations between devices (stent retriever or aspiration only [manual or pump aspiration system]) was performed. Primary outcomes were good recanalization (i.e., modified thrombolysis in cerebral infarction score ≥2b) and a favorable modified Rankin scale (mRS) score (i.e. ≤2). The secondary outcome was symptomatic intracerebral hemorrhage (sICH).
Results: A total of 197 AIS patients underwent MCA M2 ELVO thrombectomy with either a stent retriever (n = 120) or aspiration only (n = 77). The aspiration-only group utilized either manual (n = 38) or pump aspiration (n = 39). Utilization of a stent retriever over manual aspiration is independently associated with higher odds of a favorable mRS score (OR = 3.2; 95% CI 1.02-9.7) and lower odds of sICH (OR = 0.09; 95% CI 0.03-0.31). Utilization of a stent retriever over a pump aspiration system is independently associated with higher odds of good recanalization (OR = 3.8; 95% CI 1.5-9.6). Utilization of a newer-generation pump aspiration catheter compared to a stent retriever resulted in similar rates of favorable mRS scores, sICH, successful recanalization, and mortality.
Conclusion: Utilization of a newer-generation pump aspiration catheter compared to a stent retriever resulted in similar outcomes, but worse outcomes were seen with the manual aspiration technique. These findings need to be confirmed with a large randomized trial utilizing stent retrievers and newer-generation pump aspiration systems.
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