M2段大脑中动脉闭塞血管内治疗中再分析尝试的预后价值。

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY International Journal of Stroke Pub Date : 2024-04-01 Epub Date: 2023-11-22 DOI:10.1177/17474930231214769
Laurens Winkelmeier, Christian Heitkamp, Tobias D Faizy, Gabriel Broocks, Helge Kniep, Lukas Meyer, Maxim Bester, Caspar Brekenfeld, Maximilian Schell, Uta Hanning, Götz Thomalla, Jens Fiehler, Fabian Flottmann
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引用次数: 0

摘要

背景:越来越多的证据表明血管内治疗大脑中动脉M2闭塞的疗效。为了在M2闭塞中实现成功的再灌注,通常需要进行一次以上的再通尝试,这与对这些中等血管闭塞中多次操作的安全性的普遍担忧有关。目的:与大血管闭塞(LVO)相比,研究M2闭塞再通尝试次数与功能结果之间的关系。方法:对接受原发性M2闭塞血管内治疗的患者进行回顾性多中心队列研究。2015-2021年间,25个综合卒中中心中有1个的患者被纳入德国卒中登记处。研究队列被细分为在第1次、第2次、第3次、第4次或≥第5次再通尝试时再灌注失败(mTICI 0-2a)和再灌注成功(mTICI2b/3)的患者。主要结果是90天的功能独立性,定义为改良兰金量表0-2分。安全性结果是出现症状性颅内出血。颈内动脉或M1闭塞被定义为LVO,并作为对照组。结果:共纳入1078例M2闭塞患者。再灌注成功率为87.1%,90天功能独立率为51.9%。随着再通次数的增加,功能独立率逐渐下降(结论:本研究表明,在M2闭塞的血管内治疗中,在3次再通尝试内成功再灌注的临床益处与LVO相似。我们的研究结果减少了对M2中等血管闭塞多次尝试的风险/收益比的担忧。数据访问声明:支持本研究结果的数据可根据合理要求提供在GSR指导委员会批准后。
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Prognostic value of recanalization attempts in endovascular therapy for M2 segment middle cerebral artery occlusions.

Background: There is growing evidence suggesting efficacy of endovascular therapy for M2 occlusions of the middle cerebral artery. More than one recanalization attempt is often required to achieve successful reperfusion in M2 occlusions, associated with general concerns about the safety of multiple maneuvers in these medium vessel occlusions.

Aim: The aim of this study was to investigate the association between the number of recanalization attempts and functional outcomes in M2 occlusions in comparison with large vessel occlusions (LVO).

Methods: Retrospective multicenter cohort study of patients who underwent endovascular therapy for primary M2 occlusions. Patients were enrolled in the German Stroke Registry at 1 of 25 comprehensive stroke centers between 2015 and 2021. The study cohort was subdivided into patients with unsuccessful reperfusion (mTICI 0-2a) and successful reperfusion (mTICI 2b-3) at first, second, third, fourth, or ⩾fifth recanalization attempt. Primary outcome was 90-day functional independence defined as modified Rankin Scale score of 0-2. Safety outcome was the occurrence of symptomatic intracranial hemorrhage. Internal carotid artery or M1 occlusions were defined as LVO and served as comparison group.

Results: A total of 1078 patients with M2 occlusion were included. Successful reperfusion was observed in 87.1% and 90-day functional independence in 51.9%. The rate of functional independence decreased gradually with increasing number of recanalization attempts (p < 0.001). In both M2 occlusions and LVO, successful reperfusion within three attempts was associated with greater odds of functional independence, while success at ⩾fourth attempt was not. Patients with ⩾4 attempts exhibited higher rates of symptomatic intracranial hemorrhage in M2 occlusions (6.5% vs 2.7%, p = 0.02) and LVO (7.2% vs 3.5%, p < 0.001).

Conclusion: This study suggests a clinical benefit of successful reperfusion within three recanalization attempts in endovascular therapy for M2 occlusions, which was similar in LVO. Our findings reduce concerns about the risk-benefit ratio of multiple attempts in M2 medium vessel occlusions.

Data access statement: The data that support the findings of this study are available on reasonable request after approval of the German Stroke Registry (GSR) steering committee.

Clinical trial registration information: ClinicalTrials.gov Identifier: NCT03356392.

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来源期刊
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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