Mechanical Thrombectomy for Distal Occlusions: Efficacy, Functional and Safety Outcomes: Insight from the STAR Collaboration

被引：28

作者：

Anadani, Mohammad ^{[1
]}

Alawieh, Ali ^{[1
,2
]}

Chalhoub, Reda ^{[1
]}

Jabbour, Pascal ^{[3
]}

Starke, Robert M. ^{[4
]}

Arthur, Adam ^{[5
,6
]}

Goyal, Nitin ^{[5
,6
]}

Wolfe, Stacey ^{[7
]}

Fargen, Kyle M. ^{[7
]}

Grossberg, Jonathan A. ^{[2
]}

Howard, Brian M. ^{[2
]}

De Leacy, Reade ^{[8
]}

Kellner, Christopher ^{[8
]}

Kan, Peter ^{[9
]}

Dumont, Travis ^{[11
]}

Rai, Ansaar ^{[12
]}

Osbun, Joshua ^{[13
]}

Crosa, Roberto ^{[14
]}

Maier, Ilko ^{[15
]}

Nascimento, Fabio A. ^{[10
]}

Park, Min S. ^{[16
]}

Levitt, Michael R. ^{[17
]}

Fragata, Isabel ^{[18
]}

Matouk, Charles ^{[19
]}

Crowley, R. Webster ^{[20
]}

Chowdhry, Shakeel A. ^{[21
]}

Ogilvy, Christopher ^{[22
]}

Mokin, Maxim ^{[23
]}

Mascitelli, Justin ^{[24
]}

Yoo, Albert J. ^{[25
]}

Williamson, Richard W. ^{[26
]}

Webb, Sharon ^{[27
]}

Psychogios, Marios-Nikos ^{[28
]}

Al Kasab, Sami ^{[1
]}

Spiotta, Alejandro M. ^{[1
]}

机构：

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

[2] Emory Univ, Dept Neurosurg, Atlanta, GA USA

[3] Thomas Jefferson Univ Hosp, Dept Neurosurg, Philadelphia, PA USA

[4] Univ Miami, Miller Sch Med, Dept Neurosurg & Radiol, Miami, FL USA

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

[6] Semmes Murphey Clin, Memphis, TN USA

[7] Wake Forest Univ, Dept Neurosurg, Winston Salem, NC USA

[8] Mt Sinai Hlth Syst, Dept Neurosurg, New York, NY USA

[9] Baylor Coll Med, Dept Neurosurg, Houston, TX USA

[10] Baylor Coll Med, Dept Neurol, Houston, TX USA

[11] Banner Univ, Dept Neurosurg, Arizona Med Ctr, Tucson, AZ USA

[12] West Virginia Univ, Dept Radiol, Morgantown, WV USA

[13] Washington Univ, Dept Neurosurg, St Louis, MO USA

[14] Ctr Endovasc Neurol, Med Uruguaya, Montevideo, Uruguay

[15] Univ Med Ctr Gottingen, Dept Neurol, Gottingen, Germany

[16] Univ Virginia, Dept Neurosurg, Charlottesville, VA USA

[17] Univ Washington, Dept Neurosurg, Seattle, WA USA

[18] Ctr Hosp Univ Lisboa Cent, Dept Neurosurg, Lisbon, Portugal

[19] Yale Sch Med, Dept Neurosurg, New Haven, CT USA

[20] Rush Univ, Dept Neurosurg, Chicago, IL USA

[21] Northshore Univ Hlth Syst, Dept Neurosurg, Evanston, IL USA

[22] Beth Israel Deaconess Med Ctr, Dept Neurosurg, Boston, MA USA

[23] Univ S Florida, Dept Neurosurg, Tampa, FL USA

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

[25] Texas Stroke Inst, Dallas, TX USA

[26] Allegheny Gen Hosp, Dept Neurosurg, Pittsburgh, PA 15212 USA

[27] Bon Secours Med Ctr, Dept Neurosurg, Greenville, SC USA

[28] Univ Hosp Basel, Dept Neuroradiol, Basel, Switzerland

来源：

WORLD NEUROSURGERY | 2021年 / 151卷

基金：

美国国家卫生研究院;

关键词：

Distal occlusion; Hemorrhage; Stroke; Thrombectomy; TISSUE-PLASMINOGEN ACTIVATOR; INDIVIDUAL PATIENT DATA; ISCHEMIC-STROKE; INTRAVENOUS THROMBOLYSIS; METAANALYSIS; REPERFUSION; EXPERIENCE;

D O I：

10.1016/j.wneu.2021.04.136

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

-BACKGROUND: Mechanical thrombectomy (MT) is the standard of care for the treatment of proximal anterior circulation large vessel occlusions. However, little is known about its efficacy and safety in the treatment of distal intracranial occlusions. -METHODS: This is a multicenter retrospective study of patients treated with MT at 15 comprehensive centers between January 2015 and December 2018. The study cohort was divided into 2 groups based on the location of occlusion (proximal vs. distal). Distal occlusion was defined as occlusion of M3 segment of the middle cerebral artery, any segment of the anterior cerebral artery, or any segment of the posterior cerebral artery. Only isolated distal occlusion was included. Good outcome was defined as 90-day modified Rankin scale score 0e2. -RESULTS: A total of 4710 patients were included in this study, of whom 189 (4%) had MT for distal occlusions. Compared with the proximal occlusion group, distal occlusion group had a higher rate of good outcome (45% vs. 36%; P = 0.03) and a lower rate of successful reperfusion (78% vs. 84%; P = 0.04). However, the differences did not retain significance in adjusted models. Otherwise there was no difference in the rate of hemorrhagic complications, mortality, or procedure-related complications between the 2 groups. Successful reperfusion, age, and admission stroke severity emerged as predictors of good functional outcome in the distal occlusion group. CONCLUSIONS: Thrombectomies of distal vessels achieve high rate of successful reperfusion with similar safety profile to those in more proximal locations.

引用

页码：E871 / E879

页数：9

共 25 条

[1] Technical and Clinical Outcomes After Thrombectomy for the Various Segments of the Middle Cerebral Artery [J].

Alawieh, Ali ;

Kellogg, Ryan T. ;

Chatterjee, A. Rano ;

Korson, Clayton ;

Lajthia, Orgest ;

Anadani, Mohammad ;

Lena, Jonathan ;

Spiotta, Alejandro M. .

WORLD NEUROSURGERY, 2019, 128 :E445-E453

[2] Thrombectomy Technique Predicts Outcome in Posterior Circulation Stroke-Insights from the STAR Collaboration [J].

Alawieh, Ali M. ;

Eid, Maya ;

Anadani, Mohammad ;

Sattur, Mithun ;

Maier, Ilko L. ;

Feng, Wuwei ;

Goyal, Nitin ;

Starke, Robert M. ;

Rai, Ansaar ;

Fargen, Kyle M. ;

Psychogios, Marios-Nikos ;

De Leacy, Reade ;

Grossberg, Jonathan A. ;

Keyrouz, Salah G. ;

Dumont, Travis M. ;

Kan, Peter ;

Lena, Jonathan ;

Liman, Jan ;

Arthur, Adam S. ;

Elijovich, Lucas ;

Mccarthy, David J. ;

Saini, Vasu ;

Wolfe, Stacey Q. ;

Mocco, J. ;

Fifi, Johanna T. ;

Nascimento, Fabio A. ;

Giles, James A. ;

Allen, Michelle ;

Crosa, Roberto ;

Fox, W. Christopher ;

Gory, Benjamin ;

Spiotta, Alejandro M. .

NEUROSURGERY, 2020, 87 (05) :982-991

[3] Intra-Arterial Tissue Plasminogen Activator Is a Safe Rescue Therapy with Mechanical Thrombectomy [J].

Anadani, Mohammad ;

Ajinkya, Shaun ;

Alawieh, Ali ;

Vargas, Jan ;

Chatterjee, Arindam ;

Turk, Aquilla ;

Spiotta, Alejandro M. .

WORLD NEUROSURGERY, 2019, 123 :E604-E608

[4]

Berkhemer OA, 2015, NEW ENGL J MED, V372, P394

[5] Low Rates of Acute Recanalization With Intravenous Recombinant Tissue Plasminogen Activator in Ischemic Stroke Real-World Experience and a Call for Action [J].

Bhatia, Rohit ;

Hill, Michael D. ;

Shobha, Nandavar ;

Menon, Bijoy ;

Bal, Simerpreet ;

Kochar, Puneet ;

Watson, Tim ;

Goyal, Mayank ;

Demchuk, Andrew M. .

STROKE, 2010, 41 (10) :2254-2258

[6] Safety and Efficacy of Solitaire Stent Thrombectomy Individual Patient Data Meta-Analysis of Randomized Trials [J].

Campbell, Bruce C. V. ;

Hill, Michael D. ;

Rubiera, Marta ;

Menon, Bijoy K. ;

Demchuk, Andrew ;

Donnan, Geoffrey A. ;

Roy, Daniel ;

Thornton, John ;

Dorado, Laura ;

Bonafe, Alain ;

Levy, Elad I. ;

Diener, Hans-Christoph ;

Hernandez-Perez, Maria ;

Pereira, Vitor Mendes ;

Blasco, Jordi ;

Quesada, Helena ;

Rempel, Jeremy ;

Jahan, Reza ;

Davis, Stephen M. ;

Stouch, Bruce C. ;

Mitchell, Peter J. ;

Jovin, Tudor G. ;

Saver, Jeffrey L. ;

Goyal, Mayank .

STROKE, 2016, 47 (03) :798-806

[7] Insights Into Intra-arterial Thrombolysis in the Modern Era of Mechanical Thrombectomy [J].

Castonguay, Alicia C. ;

Jumaa, Mouhammad A. ;

Zaidat, Osama O. ;

Haussen, Diogo C. ;

Jadhav, Ashutosh ;

Salahuddin, Hisham ;

Zaidi, Syed F. .

FRONTIERS IN NEUROLOGY, 2019, 10

[8] Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke [J].

Goyal, M. ;

Demchuk, A. M. ;

Menon, B. K. ;

Eesa, M. ;

Rempel, J. L. ;

Thornton, J. ;

Roy, D. ;

Jovin, T. G. ;

Willinsky, R. A. ;

Sapkota, B. L. ;

Dowlatshahi, D. ;

Frei, D. F. ;

Kamal, N. R. ;

Montanera, W. J. ;

Poppe, A. Y. ;

Ryckborst, K. J. ;

Silver, F. L. ;

Shuaib, A. ;

Tampieri, D. ;

Williams, D. ;

Bang, O. Y. ;

Baxter, B. W. ;

Burns, P. A. ;

Choe, H. ;

Heo, J. -H. ;

Holmstedt, C. A. ;

Jankowitz, B. ;

Kelly, M. ;

Linares, G. ;

Mandzia, J. L. ;

Shankar, J. ;

Sohn, S. -I. ;

Swartz, R. H. ;

Barber, P. A. ;

Coutts, S. B. ;

Smith, E. E. ;

Morrish, W. F. ;

Weill, A. ;

Subramaniam, S. ;

Mitha, A. P. ;

Wong, J. H. ;

Lowerison, M. W. ;

Sajobi, T. T. ;

Hill, M. D. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1019-1030

[9] MeVO: the next frontier? [J].

Goyal, Mayank ;

Ospel, Johanna Maria ;

Menon, Bijoy K. ;

Hill, Michael D. .

JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2020, 12 (06) :545-547

[10] Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials [J].

Goyal, Mayank ;

Menon, Bijoy K. ;

van Zwam, Wim H. ;

Dippel, Diederik W. J. ;

Mitchell, Peter J. ;

Demchuk, Andrew M. ;

Davalos, Antoni ;

Majoie, Charles B. L. M. ;

van der Lugt, Aad ;

de Miquel, Maria A. ;

Donnan, Geoff Rey A. ;

Roos, Yvo B. W. E. M. ;

Bonafe, Alain ;

Jahan, Reza ;

Diener, Hans-Christoph ;

van den Berg, Lucie A. ;

Levy, Elad I. ;

Berkhemer, Olvert A. ;

Pereira, Vitor M. ;

Rempel, Jeremy ;

Millan, Monica ;

Davis, Stephen M. ;

Roy, Daniel ;

Thornton, John ;

San Roman, Luis ;

Ribo, Marc ;

Beumer, Debbie ;

Stouch, Bruce ;

Brown, Scott ;

Campbell, Bruce C. V. ;

van Oostenbrugge, Robert J. ;

Saver, Jeff Rey L. ;

Hill, Michael D. ;

Jovin, Tudor G. .

LANCET, 2016, 387 (10029) :1723-1731

← 1 2 3 →