医学
支架
血栓
放射科
闭塞
溶栓
纸牌密码算法
外科
心脏病学
缺血
缺血性中风
改良兰金量表
心肌梗塞
作者
Taichiro Imahori,Yusuke Okamura,Junichi Sakata,Hiroyasu Shose,Akiyoshi Yokote,Kazushi Matsushima,Daisuke Matsui,Makoto Kobayashi,Kohkichi Hosoda,Kazuhiro Tanaka,Atsushi Fujita,Eiji Kohmura
标识
DOI:10.1016/j.wneu.2018.12.087
摘要
Interaction between the stent retriever and clot is a key factor for recanalization during mechanical thrombectomy. The aim of this study was to evaluate the association between radiographically apparent features during thrombectomy and angiographic outcomes using the Trevo stent retriever with a fully radiopaque strut. We retrospectively reviewed 50 patients with acute middle cerebral artery occlusion who were treated with the Trevo. Patients were divided into groups that achieved (first-pass recanalization group, n = 21) or did not achieve (non–first-pass recanalization group, n = 29) a modified Thrombolysis in Cerebral Ischemia score of 2b or 3 with the first-pass procedure. Patients were also divided into a thromboembolic (n = 39) and atherosclerotic (n = 11) group by occlusion etiology. We evaluated radiographic findings of the Trevo's strut (e.g., degree of stent expansion and filling defect of the thrombus in the strut [in-stent thrombus sign]) during the first-pass procedure. Median stent expansion was significantly greater in the first-pass recanalization group than in the non–first-pass recanalization group (60% vs. 34%; P < 0.01) and in the thromboembolic group than in the atherosclerotic group (45% vs. 31%; P < 0.01). The receiver operator characteristic curve showed moderate capacity for prediction of recanalization and etiology, with an area under the curve of 0.83 and 0.73, respectively. In-stent thrombus sign was significantly more common in the thromboembolic group than in the atherosclerotic group (86% vs. 10%; P < 0.01). Greater stent expansion was associated with recanalization after thrombectomy. The in-stent thrombus sign may be useful for etiology prediction. These radiographic findings could provide useful real-time feedback during procedures, reflecting clot-stent interaction.
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