First-Pass Effect in M1-Occlusion Stroke Patients Treated with Combined Stent-Retriever/Large-Bore Distal Aspiration Catheter Thrombectomy

被引：5

作者：

Remollo, S. ^{[1
]}

Werner, M. ^{[1
]}

Blasco, J. ^{[2
]}

Lopez-Rueda, A. ^{[2
]}

San Roman, L. ^{[2
]}

Jimenez-Gomez, E. ^{[3
]}

Rey, I. Bravo ^{[4
]}

Vega, P. ^{[5
]}

Murias, E. ^{[5
]}

Rosati, S. ^{[6
]}

Perez-Garcia, C. ^{[6
]}

Gonzalez, E. ^{[7
]}

Manso, X. ^{[7
]}

Aixut, S. ^{[8
]}

Chaparro, O. Chirife ^{[8
]}

Terceno, M. ^{[9
]}

Bashir, S. ^{[9
]}

Pumar, J. M. ^{[10
]}

Ruiz-Gonzalez, E. ^{[11
]}

Mendez, J. C. ^{[12
]}

Aguilar Tejedor, Y. ^{[13
]}

Zamarro, J. ^{[14
]}

Castano, M. ^{[15
]}

Daunis-I-Estadella, P. ^{[16
]}

Puig, J. ^{[17
,18
]}

机构：

[1] Hosp Badalona Germans Trias & Pujol, Intervent Neuroradiol Unit, Badalona, Spain

[2] Hosp Clin Barcelona, Neurointervent Dept CDI, Barcelona, Spain

[3] Hosp Univ Reina Sofia, Diagnost & Therapeut Neuroradiol Unit, Cordoba, Spain

[4] Hosp Univ Reina Sofia, Neuroradiol Dept, Cordoba, Spain

[5] Hosp Univ Cent Asturias, Radiol Dept, Oviedo, Spain

[6] Hosp Clin Univ San Carlos, Neurointervent Unit, Madrid, Spain

[7] Cruces Univ Hosp, Radiol Dept, Intervent Neuroradiol, Baracaldo, Spain

[8] Hosp Univ Bellvitge, Hosp Llobregat, Neuroradiol Dept, Lhospitalet De Llobregat, Spain

[9] Hosp Univ Girona Doctor Josep Trueta, Dept Neurol, Stroke Unit, Girona, Spain

[10] Complexo Hosp Univ Santiago de Compostela, Neuroradiol Dept, Santiago De Compostela, Spain

[11] Hosp Gen Univ Alicante, Intervent Neuroradiol, Alicante, Spain

[12] Hosp Univ Ramon & Cajal, Intervent Neuroradiol, Madrid, Spain

[13] Hosp Univ Insular Gran Canaria, Radiol Dept, Gran Canaria, Spain

[14] Hosp Clin Univ Virgen de la Arrixaca, Intervent Neuroradiol, Murcia, Spain

[15] Hosp Univ Salamanca, Dept Radiol, Intervent Neuroradiol Unit, Salamanca, Spain

[16] Univ Girona, Dept Comp Sci Appl Math & Stat, Girona, Spain

[17] Hosp Univ Doctor Josep Trueta, Dept Radiol IDI, Girona, Spain

[18] Hosp Univ Doctor Josep Trueta, Inst Invest Biomed Girona, Girona, Spain

来源：

CLINICAL NEURORADIOLOGY | 2023年 / 33卷 / 03期

关键词：

Ischemia; Endovascular; Treatment; Outcome; Recovery; ACUTE ISCHEMIC-STROKE; LARGE VESSEL OCCLUSION; RETRIEVAL; MULTICENTER;

D O I：

10.1007/s00062-023-01264-4

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

IntroductionCombined stent-retriever/large-bore distal aspiration catheter (LB-DAC) thrombectomy was recently introduced to treat large-vessel occlusion; however, it is unclear whether larger inner diameters improve outcomes. We compared angiographic and clinical outcomes in patients with occlusions of the M1 segment of the middle cerebral artery treated with mechanical thrombectomy using extra-LB-DAC versus LB-DAC in combination with stent-retrievers.MethodsWe analyzed consecutive patients with M1 occlusion included in the ROSSETTI registry treated with non-balloon guide catheter combined LB-DAC/stent-retriever thrombectomy between June 2019 and April 2022. We compared demographics, baseline clinical variables, procedural variables, angiographic outcomes, and clinical outcomes [National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) and modified Rankin scale score at 3 months] between patients treated with extra-LB-DAC (Sofia Plus, MIVI Q6, Catalyst7; inner diameter, 0.068 ''-0.070 '') versus LB-DAC (Sofia 5F, MIVI Q5, Catalyst 6; inner diameter, 0.055 ''-0.064 ''). Primary outcome was the first-pass effect (FPE) rate, defined as near-complete/complete reperfusion (mTICI 2c-3) after a single pass of the device.ResultsWe included 324 patients (extra-LB-DAC, 185, 57.1% patients). Demographics, clinical data, and clinical outcomes were similar between the two groups; however, there was a trend towards improvement in National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) in the cohort treated with extra-LB-DAC 9 points (IQR 4;16 points) vs. 12 points (IQR 4;18 points, P = 0.083). Patients treated with extra-LB-DAC had higher FPE rate (47% vs. 30.9%; P = 0.003) and higher modified FPE (mTICI >= 2b after a single pass) rate (65.9% vs 46.8%; P = 0.001). The use of extra-LB-DAC was an independent factor in predicting FPE (odds ratio 1.982, 95% confidence interval 1.250-3.143, P = 0.004).ConclusionOur results suggest that in combined LB-DAC/stent-retriever thrombectomy, a larger aspiration catheter inner diameter is associated with higher rates of FPE and mFPE.

引用

页码：701 / 708

页数：8