Multicenter investigation of technical and clinical outcomes after thrombectomy for distal vessel occlusion by frontline technique

被引：21

作者：

Alawieh, Ali M. ^{[1
]}

Chalhoub, Reda M. ^{[2
]}

Al Kasab, Sami ^{[3
]}

Jabbour, Pascal ^{[4
]}

Psychogios, Marios-Nikos ^{[5
]}

Starke, Robert M. ^{[6
]}

Arthur, Adam S. ^{[7
,8
]}

Fargen, Kyle M. ^{[9
]}

De Leacy, Reade ^{[10
]}

Kan, Peter ^{[11
]}

Dumont, Travis M. ^{[12
]}

Rai, Ansaar ^{[13
]}

Crosa, Roberto Javier ^{[14
]}

Maier, Ilko ^{[15
]}

Goyal, Nitin ^{[16
]}

Wolfe, Stacey Q. ^{[17
]}

Cawley, C. Michael ^{[1
]}

Mocco, J. ^{[10
]}

Tjoumakaris, Stavropoula, I ^{[18
]}

Howard, Brian M. ^{[1
,19
]}

Dimisko, Laurie ^{[20
]}

Saad, Hassan

Ogilvy, Christopher S. ^{[21
]}

Crowley, R. Webster ^{[22
]}

Mascitelli, Justin R. ^{[23
]}

Fragata, Isabel ^{[24
]}

Levitt, Michael R. ^{[25
]}

Kim, Joon-tae ^{[26
]}

Park, Min S. ^{[27
]}

Gory, Benjamin ^{[28
]}

Polifka, Adam J. ^{[29
]}

Matouk, Charles ^{[30
]}

Grossberg, Jonathan A. ^{[1
]}

Spiotta, Alejandro M. ^{[2
]}

机构：

[1] Emory Univ, Sch Med, Dept Neurosurg, Atlanta, GA 30322 USA

[2] Med Univ South Carolina, Neurosurg, Charleston, SC 29425 USA

[3] Med Univ South Carolina, Neurol, Charleston, SC USA

[4] Thomas Jefferson Univ, Neurol Surg, Philadelphia, PA USA

[5] Univ Hosp Basel, Dept Neuroradiol Clin Radiol & Nucl Med, Basel, Switzerland

[6] Univ Miami, Miller Sch Med, Neurol Surg, Miami, FL USA

[7] Semmes Murphey Neurol & Spine Inst, Memphis, TN USA

[8] Univ Tennessee, Hlth Sci Ctr, Neurosurg, Memphis, TN USA

[9] Wake Forest Univ, Neurosurg, Winston Salem, NC USA

[10] Icahn Sch Med Mt Sinai, Neurosurg, New York, NY USA

[11] Univ Texas Med Branch, Neurosurg, Galveston, TX USA

[12] Univ Arizona, Arizona Hlth Sci Ctr, Dept Surg, Div Neurosurg, Tucson, AZ USA

[13] West Virginia Univ Hosp, Radiol, Morgantown, WV USA

[14] Med Uruguaya, Endovasc Neurosurg, Montevideo, Uruguay

[15] Univ Med Goettingen, Neurol, Gottingen, NS, Germany

[16] Univ Tennessee, Hlth Sci Ctr, Neurol, Memphis, TN USA

[17] Wake Forest Sch Med, Neurosurg, Winston Salem, NC USA

[18] Thomas Jefferson Univ Hosp, Neurol Surg, Philadelphia, PA USA

[19] Emory Univ, Sch Med, Radiol & Imaging Sci, Atlanta, GA USA

[20] Emory Healthcare, Atlanta, GA USA

[21] BIDMC, Neurosurg, Boston, MA USA

[22] Rush Univ, Neurosurg, Chicago, IL USA

[23] Univ Texas San Antonio, Hlth Sci Ctr, Dept Neurosurg, San Antonio, TX USA

[24] Ctr Hosp Lisboa Cent, Neuroradiol, Lisbon, Portugal

[25] Univ Washington, Sch Med, Neurol Surg, Seattle, WA USA

[26] Chonnam Natl Univ, Neurol, Gwangju, Jeollanam Do, South Korea

[27] Univ Virginia, Neurosurg, Charlottesville, VA USA

[28] CHRU Nancy, Dept Diagnost & Intervent Neuroradiol, Nancy, France

[29] Univ Florida, Dept Neurosurg, Gainesville, FL USA

[30] Yale Univ, Neurosurg, New Haven, CT USA

来源：

JOURNAL OF NEUROINTERVENTIONAL SURGERY | 2023年 / 15卷 / E1期

基金：

美国国家科学基金会;

关键词：

Thrombectomy; Device; Stroke; ACUTE ISCHEMIC-STROKE; STENT-RETRIEVER THROMBECTOMY; CONTACT ASPIRATION; TRIAL; ADAPT; TIME;

D O I：

10.1136/jnis-2022-019023

中图分类号：

R445 [影像诊断学];

学科分类号：

100207 ;

摘要：

Background Endovascular thrombectomy (EVT) is the standard-of-care for proximal large vessel occlusion (LVO) stroke. Data on technical and clinical outcomes in distal vessel occlusions (DVOs) remain limited. Methods This was a retrospective study of patients undergoing EVT for stroke at 32 international centers. Patients were divided into LVOs (internal carotid artery/M1/vertebrobasilar), medium vessel occlusions (M2/A1/P1) and isolated DVOs (M3/M4/A2/A3/P2/P3) and categorized by thrombectomy technique. Primary outcome was a good functional outcome (modified Rankin Scale <= 2) at 90 days. Secondary outcomes included recanalization, procedure-time, thrombectomy attempts, hemorrhage, and mortality. Multivariate logistic regressions were used to evaluate the impact of technical variables. Propensity score matching was used to compare outcome in patients with DVO treated with aspiration versus stent retriever Results We included 7477 patients including 213 DVOs. Distal location did not independently predict good functional outcome at 90 days compared with proximal (p=0.467). In distal occlusions, successful recanalization was an independent predictor of good outcome (adjusted odds ratio (aOR) 5.11, p<0.05) irrespective of technique. Younger age, bridging therapy, and lower admission National Institutes of Health Stroke Scale (NIHSS) were also predictors of good outcome. Procedure time <= 1 hour or <= 3 thrombectomy attempts were independent predictors of good outcomes in DVOs irrespective of technique (aOR 4.5 and 2.3, respectively, p<0.05). There were no differences in outcomes in a DVO matched cohort of aspiration versus stent retriever. Rates of hemorrhage and good outcome showed an exponential relationship to procedural metrics, and were more dependent on time in the aspiration group and attempts in the stent retriever group. Conclusions Outcomes following EVT for DVO are comparable to LVO with similar results between techniques. Techniques may exhibit different futility metrics; stent retriever thrombectomy was influenced by attempts whereas aspiration was more dependent on procedure time.

引用

页码：E93 / E101

页数：9

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