根据中风机械血栓切除术中的动脉直径确定抽吸导管的最佳尺寸

IF 3 3区 医学 Q2 CLINICAL NEUROLOGY Journal of Neuroradiology Pub Date : 2024-02-01 DOI:10.1016/j.neurad.2023.01.158
Guillaume Charbonnier , Panagiotis Primikiris , Maxime Desmarets , Gregory Tio , Sergio Vancheri , Fortunato Di Caterino , Giovanni Vitale , Alessandra Biondi
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引用次数: 0

摘要

背景急性缺血性脑卒中的机械性血栓切除术非常有效,包括不同的技术方法。操作者使用直接抽吸器、支架回取器或两者结合使用。目的我们研究了导管直径与闭塞血管直径之间的关系以及再通成功率。材料和方法我们对一系列连续接受机械血栓切除术治疗的患者进行了回顾性单中心研究。对于每次手术,我们都提取了每次使用直接抽吸术的尝试,并将尝试评定为成功或不成功。我们还测量了闭塞动脉的直径,并计算了闭塞动脉和抽吸导管直径之间的比值。我们检验了直径比与再通畅状态之间的关联。我们还对三位介入神经放射科医生之间的动脉直径测量结果进行了评定。直径比值越大,再通率越高。三等分分析显示,当直径比为 0.71 与 0.54 时,成功几率要高出 4.80(P 为 0.01)。结论我们证明了较高的再通率与抽吸导管和闭塞动脉之间的直径比>0.71有关。这些结果可以指导术中决策,在机械血栓切除术中适当选择抽吸导管,提高成功再通率。更大规模的研究可提供更多数据,进一步明确最佳比例。
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Defining the optimal size of an aspiration catheter in relation to the arterial diameter during mechanical thrombectomy for stroke

Background

Mechanical thrombectomy for acute ischemic stroke is effective and includes different technical approaches. Operators use direct aspiration, a stent retriever, or a combination of both. Direct aspiration can be performed with various catheters of different sizes depending on the diameter of the occluded vessel.

Purpose

We studied the relationship between the catheter diameter in regards to the occluded vessel diameter and the rate of successful recanalization.

Materials and methods

We conducted a retrospective, monocentric study on a series of consecutive patients treated with mechanical thrombectomy. For each procedure, we extracted each attempt that used direct aspiration and rated the attempt as successful or unsuccessful. We also measured the occluded artery diameter and calculated the ratio between the occluded artery and the aspiration catheter diameters. We tested the association between the diameter ratio and the recanalization status. We also performed inter-rater agreement for the arterial diameter measurement between three interventional neuroradiologists.

Results

We included 119 patients with 201 attempts of direct aspiration. A higher diameter ratio was associated with a higher recanalization rate. The analysis in terciles showed that the odds of success were 4.80 higher when the ratio was >0.71 vs <0.54 (p < 0.01). Inter-rater agreement showed near-perfect intraclass correlation with 0.93 (0.91–0.94) consistency and 0.92 (0.90–0.94) absolute agreement.

Conclusions

We demonstrated an association between higher recanalization and a diameter of ratio >0.71 between the aspiration catheter and the occluded artery. These results could guide intraoperative decisions regarding the appropriate selection of aspiration catheters during mechanical thrombectomy increasing the rate of successful recanalisation. A larger study could provide additional data to further specify the optimal ratio.

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来源期刊
Journal of Neuroradiology
Journal of Neuroradiology 医学-核医学
CiteScore
6.10
自引率
5.70%
发文量
142
审稿时长
6-12 weeks
期刊介绍: The Journal of Neuroradiology is a peer-reviewed journal, publishing worldwide clinical and basic research in the field of diagnostic and Interventional neuroradiology, translational and molecular neuroimaging, and artificial intelligence in neuroradiology. The Journal of Neuroradiology considers for publication articles, reviews, technical notes and letters to the editors (correspondence section), provided that the methodology and scientific content are of high quality, and that the results will have substantial clinical impact and/or physiological importance.
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