Stent Retriever Thrombectomy in Patients Who Are Ineligible for Intravenous Thrombolysis: A Multicenter Retrospective Observational Study

被引：13

作者：

Dorn, F. ^{[1
,2
,6
]}

Prothmann, S. ^{[4
]}

Patzig, M. ^{[6
]}

Lockau, H. ^{[1
,2
]}

Kabbasch, C. ^{[1
,2
]}

Nikoubashman, O. ^{[8
]}

Liebig, T. ^{[1
,2
]}

Zimmer, C. ^{[4
]}

Brueckmann, H. ^{[6
]}

Wiesmann, M. ^{[8
]}

Stetefeld, H. ^{[3
]}

Poppert, H. ^{[5
]}

Reich, A. ^{[9
]}

Kellert, L. ^{[7
]}

Fesl, G. ^{[6
]}

机构：

[1] Univ Hosp Cologne, Dept Neuroradiol, Cologne, Germany

[2] Univ Hosp, Dept Radiol, Cologne, Germany

[3] Univ Hosp, Dept Neurol, Cologne, Germany

[4] Tech Univ Munich, Klinikum Rechts Isar, Dept Neuroradiol, D-80290 Munich, Germany

[5] Tech Univ Munich, Klinikum Rechts Isar, Dept Neurol, D-80290 Munich, Germany

[6] Univ Hosp Munich, Dept Neuroradiol, Marchioninistr 15, D-81377 Munich, Germany

[7] Univ Hosp, Dept Neurol, Munich, Germany

[8] Univ Hosp Aachen, Dept Neuroradiol, Aachen, Germany

[9] Univ Hosp, Dept Neurol, Aachen, Germany

来源：

AMERICAN JOURNAL OF NEURORADIOLOGY | 2016年 / 37卷 / 02期

关键词：

ACUTE ISCHEMIC-STROKE; INTRACEREBRAL ARTERY OCCLUSIONS; TISSUE-PLASMINOGEN-ACTIVATOR; MECHANICAL THROMBECTOMY; ENDOVASCULAR TREATMENT; RANDOMIZED-TRIAL; MERCI TRIAL; RECANALIZATION; INTRAARTERIAL; REVASCULARIZATION;

D O I：

10.3174/ajnr.A4520

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: Intravenous thrombolysis with rtPA is the standard of care for patients with acute ischemic stroke within 4.5 hours after symptom onset. However, a considerable number of patients are ineligible for IV thrombolysis due to various contraindications. Recent studies have proved the superiority of mechanical thrombectomy for patients with large-vessel occlusions in combination with IV rtPA compared with IV rtPA alone. We aimed to demonstrate the efficacy of mechanical thrombectomy for patients who are ineligible for IV rtPA. MATERIALS AND METHODS: Patients from the stroke registries of 4 dedicated centers who were treated with mechanical thrombectomy from January 2010 to October 2014 were retrospectively evaluated. Inclusion criteria were the following: acute stroke due to proved large-artery occlusion, ineligibility for IV thrombolysis, and a timeframe of 4.5 hours between stroke and the start of mechanical thrombectomy. Recanalization success, periprocedural complications, clinical outcome, and hemorrhages were evaluated. RESULTS: One hundred thirty endovascular recanalization procedures were identified. The locations were the following: proximal ICA in 17 (13.1%), terminus ICA in 25 (19.2%), M1 segment in 77 (59.2%), and M2 segment in 11 (8.5%). TICI 2b/3 results were achieved in 101 (77.7%), and an mRS score of 0-2 in 47 patients (37.9%). There was a significant correlation between TICI 2b/3 results and good clinical outcomes (87.2% versus 6.8%; P = .048). A good clinical result was most frequent when recanalization was achieved within 4.5 hours (37/74 = 50% versus 10/50 = 20.0%; P = .001). Symptomatic hemorrhage occurred in 13.1% of patients; mortality was 24.2%. Periprocedural complications were recorded in 10 patients (7.7%). CONCLUSIONS: Mechanical thrombectomy can achieve good clinical outcomes in patients with acute large-artery occlusion ineligible for IV thrombolysis, in particular when recanalization is reached early.

引用

页码：305 / 310

页数：6

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