医学
溶栓
改良兰金量表
闭塞
大脑中动脉
脑出血
颈内动脉
脑梗塞
冲程(发动机)
外科
心脏病学
缺血性中风
格拉斯哥昏迷指数
缺血
心肌梗塞
机械工程
工程类
作者
Pedro Vega,Eduardo Murías,Jose María Jiménez,Juan Chaviano,José A. Rodríguez,Sergio Calleja,Montserrat González Delgado,Lorena Benavente,María Mercedes Castañón,Josep Puig,Helena Cigarrán,Faustino García Arias,René Chapot
标识
DOI:10.1007/s00062-022-01161-2
摘要
Mechanical thrombectomy is the standard of care for acute ischemic stroke due to large-vessel occlusion; however, mechanical thrombectomy fails to achieve adequate recanalization in nearly one third of these cases. Rescue therapy using two stentrievers simultaneously yields good results in clots refractory to single stentriever treatment. We aimed to determine the safety and efficacy of first-line double stentriever thrombectomy for acute occlusion of the M1 segment of the middle cerebral artery and/or terminal internal carotid artery (TICA).This single-center study prospectively enrolled consecutive patients with a single M1/TICA occlusion to undergo double stentriever thrombectomy between May and October 2020. Outcomes included successful recanalization (modified thrombolysis in cerebral infarction, TICI 2b/3), first-pass effect, procedure times, number of device passes, symptomatic intracerebral hemorrhage, National Institutes of Health Stroke Scale Score (NIHSS) at discharge, 90-day functional independence (modified Rankin scale 0-2), and 90-day mortality.We analyzed 39 patients median age 79 years (range 42-96 years); 23 (58.9%) female; 19 (48.7%) with TICA occlusions; 5 (12.8%) with mRS 3-5 at admission; mean NIHSS at admission, 17 ± 4.39). Mean time from symptom onset to final angiogram was 238.0 ± 94.6 min; mean intervention duration was 36.0 ± 24.2 min. The mean number of device passes was 1.5 ± 1.07. All patients had final TICI 2b/3, and 27 (69%) had TICI 2c/3 after the first pass. We observed 3 (7.9%) cases of intracerebral symptomatic hemorrhages. At 90 days, 16 (41%) patients were functionally independent and 9 (23%) had died. The percentage of patients with good clinical outcome at 90 days was 55.5% in the first-pass subgroup.Our findings suggest that first-line double stentriever thrombectomy is safe and effective for M1/TICA occlusions.
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