Impact of Retriever Passes on Efficacy and Safety Outcomes of Acute Ischemic Stroke Treated with Mechanical Thrombectomy

被引：22

作者：

Bai, Yongjie ^{[1
,2
]}

Pu, Jie ^{[3
]}

Wang, Huaiming ^{[4
,5
]}

Yang, Dong ^{[4
]}

Hao, Yonggang ^{[6
]}

Xu, Haowen ^{[7
]}

Zhang, Meng ^{[8
]}

Geng, Yu ^{[9
]}

Wan, Yue ^{[10
]}

Wang, Wei ^{[11
]}

Zhang, Hao ^{[12
]}

Zi, Wenjie ^{[4
]}

Liu, Xinfeng ^{[1
,4
]}

Xu, Gelin ^{[1
,4
]}

机构：

[1] Nanjing Med Univ, Dept Neurol, Jinling Clin Coll, Nanjing, Jiangsu, Peoples R China

[2] Henan Univ Sci & Technol, Affiliated Hosp 1, Dept Neurol, Coll Clin Med, Luoyang 471003, Peoples R China

[3] Southern Med Univ, Jinling Hosp, Dept Neurol, Nanjing, Jiangsu, Peoples R China

[4] Nanjing Univ, Jinling Hosp, Dept Neurol, Sch Med, Nanjing 210002, Jiangsu, Peoples R China

[5] Peoples Liberat Army, Dept Neurol, Hosp 89, Weifang, Shandong, Peoples R China

[6] Soochow Univ, Dept Emergency Med, Affiliated Hosp 1, Suzhou, Jiangsu, Peoples R China

[7] Zhengzhou Univ, Dept Intervent Neuroradiol, Affiliated Hosp 1, Zhengzhou, Henan, Peoples R China

[8] Third Mil Med Univ, Inst Surg Res, Daping Hosp, Dept Neurol, Chongqing, Peoples R China

[9] Zhejiang Prov Peoples Hosp, Dept Neurol, Hangzhou, Zhejiang, Peoples R China

[10] Hubei Zhongshan Hosp, Dept Neurol, Wuhan, Hubei, Peoples R China

[11] Yangzhou Univ, Peoples Hosp Yangzhou 1, Dept Radiol, Yangzhou, Jiangsu, Peoples R China

[12] Nanjing Med Univ, Peoples Hosp Hangzhou 1, Dept Neurol, Hangzhou 310006, Zhejiang, Peoples R China

来源：

CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY | 2018年 / 41卷 / 12期

基金：

中国国家自然科学基金;

关键词：

Ischemic stroke; Mechanical thrombectomy; Stent retriever; Cerebral revascularization; Intracranial hemorrhage; ENDOVASCULAR TREATMENT; STENT-RETRIEVER; REVASCULARIZATION; PREDICTORS; CLASSIFICATION; BARRIER;

D O I：

10.1007/s00270-018-2022-0

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background and PurposeIn patients with acute ischemic stroke treated with thrombectomy, additional retriever passes may increase the likelihood of recanalization, but also the risk of intracranial hemorrhage. This multicenter retrospective register study aimed to evaluate the impact of retriever passes on treatment efficacy and safety outcomes in patients treated with mechanical thrombectomy.Materials and MethodsPatients with ischemic stroke due to large artery occlusion in anterior circulation and treated with mechanical thrombectomy were enrolled. The primary efficacy outcome was a favorable functional outcome defined as modified Rankin Scale score of 0-2 at 90days. Major safety outcome was symptomatic intracranial hemorrhage (SICH) and mortality. Multivariate logistic regression was used to analyze the impact of retriever passes on efficacy and safety outcomes.ResultsOf the 472 enrolled patients, the likelihood of favorable outcome declined in patients with more than three retriever passes (44.4% in patients with three passes, 26.3% with four passes, 14.8% with five or more passes). Multivariate logistic regression analysis identified three or less passes as an independent predictor for favorable functional outcomes (OR 2.44, 95% CI 1.10-5.45, P=0.029). More than three passes was associated with an increased risk of SICH (OR 2.24, 95% CI 1.16-4.33, P=0.016).ConclusionsMore than three retriever passes may increase the rate of recanalization, but not the likelihood of favorable functional outcomes in ischemic stroke patients treated with mechanical thrombectomy. Notably, multiple retriever passes may also increase the risk of intracranial hemorrhage.Evidence-Based MedicineLevel of Evidence: Level 4, Case Series.

引用

页码：1909 / 1916

页数：8

共 31 条

[1] CLASSIFICATION OF SUBTYPE OF ACUTE ISCHEMIC STROKE - DEFINITIONS FOR USE IN A MULTICENTER CLINICAL-TRIAL [J].

ADAMS, HP ;

BENDIXEN, BH ;

KAPPELLE, LJ ;

BILLER, J ;

LOVE, BB ;

GORDON, DL ;

MARSH, EE ;

KASE, CS ;

WOLF, PA ;

BABIKIAN, VL ;

LICATAGEHR, EE ;

ALLEN, N ;

BRASS, LM ;

FAYAD, PB ;

PAVALKIS, FJ ;

WEINBERGER, JM ;

TUHRIM, S ;

RUDOLPH, SH ;

HOROWITZ, DR ;

BITTON, A ;

MOHR, JP ;

SACCO, RL ;

CLAVIJO, M ;

ROSENBAUM, DM ;

SPARR, SA ;

KATZ, P ;

KLONOWSKI, E ;

CULEBRAS, A ;

CAREY, G ;

MARTIR, NI ;

FICARRA, C ;

HOGAN, EL ;

CARTER, T ;

GURECKI, P ;

MUNTZ, BK ;

RAMIREZLASSEPAS, M ;

TULLOCH, JW ;

QUINONES, MR ;

MENDEZ, M ;

ZHANG, SM ;

ALA, T ;

JOHNSTON, KC ;

ANDERSON, DC ;

TARREL, RM ;

NANCE, MA ;

BUDLIE, SR ;

DIERICH, M ;

HELGASON, CM ;

HIER, DB ;

SHAPIRO, RA .

STROKE, 1993, 24 (01) :35-41

[2] Intravenous Thrombolysis and Passes of Thrombectomy as Predictors for Endovascular Revascularization in Ischemic Stroke [J].

Angermaier, Anselm ;

Michel, Patrik ;

Khaw, Alexander V. ;

Kirsch, Michael ;

Kessler, Christof ;

Langner, Soenke .

JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, 2016, 25 (10) :2488-2495

[3] Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy [J].

Barber, PA ;

Demchuk, AM ;

Zhang, JJ ;

Buchan, AM .

LANCET, 2000, 355 (9216) :1670-1674

[4] A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke [J].

Berkhemer, O. A. ;

Fransen, P. S. S. ;

Beumer, D. ;

van den Berg, L. A. ;

Lingsma, H. F. ;

Yoo, A. J. ;

Schonewille, W. J. ;

Vos, J. A. ;

Nederkoorn, P. J. ;

Wermer, M. J. H. ;

van Walderveen, M. A. A. ;

Staals, J. ;

Hofmeijer, J. ;

van Oostayen, J. A. ;

Nijeholt, G. J. Lycklama A. ;

Boiten, J. ;

Brouwer, P. A. ;

Emmer, B. J. ;

de Bruijn, S. F. ;

van Dijk, L. C. ;

Kappelle, L. J. ;

Lo, R. H. ;

Van Dijk, E. J. ;

de Vries, J. ;

de Kort, P. L. M. ;

van Rooij, W. J. J. ;

van den Berg, J. S. P. ;

van Hasselt, B. A. A. M. ;

Aerden, L. A. M. ;

Dallinga, R. J. ;

Visser, M. C. ;

Bot, J. C. J. ;

Vroomen, P. C. ;

Eshghi, O. ;

Schreuder, T. H. C. M. L. ;

Heijboer, R. J. J. ;

Keizer, K. ;

Tielbeek, A. V. ;

den Hertog, H. M. ;

Gerrits, D. G. ;

van den Berg-Vos, R. M. ;

Karas, G. B. ;

Steyerberg, E. W. ;

Flach, H. Z. ;

Marquering, H. A. ;

Sprengers, M. E. S. ;

Jenniskens, S. F. M. ;

Beenen, L. F. M. ;

van den Berg, R. ;

Koudstaal, P. J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (01) :11-20

[5] Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection [J].

Campbell, B. C. V. ;

Mitchell, P. J. ;

Kleinig, T. J. ;

Dewey, H. M. ;

Churilov, L. ;

Yassi, N. ;

Yan, B. ;

Dowling, R. J. ;

Parsons, M. W. ;

Oxley, T. J. ;

Wu, T. Y. ;

Brooks, M. ;

Simpson, M. A. ;

Miteff, F. ;

Levi, C. R. ;

Krause, M. ;

Harrington, T. J. ;

Faulder, K. C. ;

Steinfort, B. S. ;

Priglinger, M. ;

Ang, T. ;

Scroop, R. ;

Barber, P. A. ;

McGuinness, B. ;

Wijeratne, T. ;

Phan, T. G. ;

Chong, W. ;

Chandra, R. V. ;

Bladin, C. F. ;

Badve, M. ;

Rice, H. ;

de Villiers, L. ;

Ma, H. ;

Desmond, P. M. ;

Donnan, G. A. ;

Davis, S. M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1009-1018

[6] Anterior cerebral artery embolism during thrombectomy increases disability and mortality [J].

Chalumeau, Vanessa ;

Blanc, Raphael ;

Redjem, Hocine ;

Ciccio, Gabriele ;

Smajda, Stanislas ;

Desilles, Jean-Philippe ;

Botta, Daniele ;

Escalard, Simon ;

Boisseau, William ;

Maier, Benjamin ;

Labreuche, Julien ;

Obadia, Mickael ;

Piotin, Michel ;

Mazighi, Mikael .

JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2018, 10 (11) :1057-1062

[7]

Eesa M, 2012, NEURORADIOLOGY, V54, P1261, DOI 10.1007/s00234-012-1039-3

[8] Histopathologic Evaluation of Arterial Wall Response to 5 Neurovascular Mechanical Thrombectomy Devices in a Swine Model [J].

Gory, B. ;

Bresson, D. ;

Kessler, I. ;

Perrin, M. L. ;

Guillaudeau, A. ;

Durand, K. ;

Ponsonnard, S. ;

Couquet, C. ;

Yardin, C. ;

Mounayer, C. .

AMERICAN JOURNAL OF NEURORADIOLOGY, 2013, 34 (11) :2192-2198

[9] 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

[10] Comparison of Neurologic and Radiographic Outcomes with Solitaire versus Merci/Penumbra Systems for Acute Stroke Intervention [J].

Hann, Shannon ;

Chalouhi, Nohra ;

Starke, Robert ;

Gandhe, Ashish ;

Koltz, Michael ;

Theofanis, Thana ;

Jabbour, Pascal ;

Gonzalez, L. Fernando ;

Rosenwasser, Robert ;

Tjoumakaris, Stavropoula .

BIOMED RESEARCH INTERNATIONAL, 2013, 2013

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