Mechanical Thrombectomy for Isolated M2 Occlusions: A Post Hoc Analysis of the STAR, SWIFT, and SWIFT PRIME Studies

被引：109

作者：

Coutinho, J. M. ^{[1
]}

Liebeskind, D. S. ^{[3
,4
]}

Slater, L. -A. ^{[1
]}

Nogueira, R. G. ^{[5
]}

Baxter, B. W. ^{[6
]}

Levy, E. I. ^{[7
]}

Siddiqui, A. H. ^{[7
,8
]}

Goyal, M. ^{[9
,10
]}

Zaidat, O. O. ^{[11
]}

Davalos, A. ^{[12
]}

Bonafe, A. ^{[13
]}

Jahan, R. ^{[14
]}

Gralla, J. ^{[17
]}

Saver, J. L. ^{[15
,16
]}

Pereira, V. M. ^{[1
,2
]}

机构：

[1] Univ Toronto, Toronto Western Hosp, Univ Hlth Network, Dept Med Imaging,Div Neuroradiol, Toronto, ON M5S 1A1, Canada

[2] Univ Toronto, Toronto Western Hosp, Univ Hlth Network, Dept Med Imaging,Div Neurosurg, Toronto, ON M5S 1A1, Canada

[3] Neurovasc Imaging Res Core, Los Angeles, CA USA

[4] Univ Calif Los Angeles, Los Angeles Stroke Ctr, Los Angeles, CA USA

[5] Emory Univ, Sch Med, Grady Mem Hosp, Marcus Stroke & Neurosci Ctr,Dept Neurol, Atlanta, GA USA

[6] Univ Tennessee, Erlanger Hosp, Dept Radiol, Chattanooga, TN USA

[7] SUNY Buffalo, Dept Neurosurg, Buffalo, NY 14260 USA

[8] SUNY Buffalo, Toshiba Stroke & Vasc Res Ctr, Buffalo, NY 14260 USA

[9] Univ Calgary, Dept Radiol, Calgary, AB, Canada

[10] Univ Calgary, Dept Clin Neurosci, Calgary, AB, Canada

[11] Med Coll Wisconsin, Dept Neurol, Milwaukee, WI 53226 USA

[12] Univ Autonoma Barcelona, Hosp Germans Trias & Pujol, Dept Neurosci, E-08193 Barcelona, Spain

[13] Hop Gui de Chauliac, Dept Neuroradiol, Montpellier, France

[14] Univ Calif Los Angeles, David Geffen Sch Med, Div Intervent Neuroradiol, Los Angeles, CA 90095 USA

[15] Univ Calif Los Angeles, David Geffen Sch Med, Dept Neurol, Los Angeles, CA 90095 USA

[16] Univ Calif Los Angeles, David Geffen Sch Med, Comprehens Stroke Ctr, Los Angeles, CA 90095 USA

[17] Univ Hosp Bern, Inselspital, Dept Diagnost & Intervent Neuroradiol, CH-3010 Bern, Switzerland

来源：

AMERICAN JOURNAL OF NEURORADIOLOGY | 2016年 / 37卷 / 04期

关键词：

ACUTE ISCHEMIC-STROKE; MIDDLE CEREBRAL-ARTERY; INTRAVENOUS T-PA; ENDOVASCULAR TREATMENT; CLINICAL-OUTCOMES; MICROSURGICAL ANATOMY; IMAGING SELECTION; POOLED ANALYSIS; TRIAL; THERAPY;

D O I：

10.3174/ajnr.A4591

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BACKGROUND AND PURPOSE: Mechanical thrombectomy is beneficial for patients with acute ischemic stroke and a proximal anterior occlusion, but it is unclear if these results can be extrapolated to patients with an M2 occlusion. The purpose of this study was to examine the technical aspects, safety, and outcomes of mechanical thrombectomy with a stent retriever in patients with an isolated M2 occlusion who were included in 3 large multicenter prospective studies. MATERIALS AND METHODS: We included patients from the Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), Solitaire With the Intention For Thrombectomy (SWIFT), and Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME) studies, 3 large multicenter prospective studies on thrombectomy for ischemic stroke. We compared outcomes and technical details of patients with an M2 with those with an M1 occlusion. All patients were treated with a stent retriever. Imaging data and outcomes were scored by an independent core laboratory. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction score of 2b/3. RESULTS: We included 50 patients with an M2 and 249 patients with an M1 occlusion. Patients with an M2 occlusion were older (mean age, 71 versus 67 years; P = .04) and had a lower NIHSS score (median, 13 versus 17; P < .001) compared with those with an M1 occlusion. Procedural time was nonsignificantly shorter in patients with an M2 occlusion (median, 29 versus 35 minutes; P = .41). The average number of passes with a stent retriever was also nonsignificantly lower in patients with an M2 occlusion (mean, 1.4 versus 1.7; P = .07). There were no significant differences in successful reperfusion (85% versus 82%, P = .82), symptomatic intracerebral hemorrhages (2% versus 2%, P = 1.0), device-related serious adverse events (6% versus 4%, P = .46), or modified Rankin Scale score 0-2 at follow-up (60% versus 56%, P = .64). CONCLUSIONS: Endovascular reperfusion therapy appears to be feasible in selected patients with ischemic stroke and an M2 occlusion.

引用

页码：667 / 672

页数：6

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