Multicenter investigation of technical and clinical outcomes after thrombectomy for distal vessel occlusion by frontline technique

医学 改良兰金量表 倾向得分匹配 闭塞 冲程(发动机) 脑出血 外科 第一次通过 优势比 回顾性队列研究 支架 内科学 缺血性中风 格拉斯哥昏迷指数 缺血 机械工程 算术 数学 工程类
作者
Ali Alawieh,Reda M. Chalhoub,Sami Al Kasab,Pascal Jabbour,Marios Psychogios,Robert M. Starke,Adam S Arthur,Kyle M Fargen,Reade De Leacy,Peter Kan,Travis M. Dumont,Ansaar Rai,Roberto Crosa,Ilko Maier,Nitin Goyal,Stacey Q Wolfe,C. Michael Cawley,J Mocco,Stavropoula Tjoumakaris,Brian M. Howard,Laurie Dimisko,Hassan Saad,Christopher S. Ogilvy,R. Webster Crowley,Justin Mascitelli,Isabel Fragata,Michael R. Levitt,Joon‐Tae Kim,Min S. Park,Benjamin Gory,Adam Polifka,Charles Matouk,Jonathan A Grossberg,Alejandro M Spiotta
出处
期刊:Journal of NeuroInterventional Surgery [BMJ]
卷期号:15 (e1): e93-e101 被引量:17
标识
DOI:10.1136/jnis-2022-019023
摘要

Endovascular thrombectomy (EVT) is the standard-of-care for proximal large vessel occlusion (LVO) stroke. Data on technical and clinical outcomes in distal vessel occlusions (DVOs) remain limited.This was a retrospective study of patients undergoing EVT for stroke at 32 international centers. Patients were divided into LVOs (internal carotid artery/M1/vertebrobasilar), medium vessel occlusions (M2/A1/P1) and isolated DVOs (M3/M4/A2/A3/P2/P3) and categorized by thrombectomy technique. Primary outcome was a good functional outcome (modified Rankin Scale ≤2) at 90 days. Secondary outcomes included recanalization, procedure-time, thrombectomy attempts, hemorrhage, and mortality. Multivariate logistic regressions were used to evaluate the impact of technical variables. Propensity score matching was used to compare outcome in patients with DVO treated with aspiration versus stent retriever RESULTS: We included 7477 patients including 213 DVOs. Distal location did not independently predict good functional outcome at 90 days compared with proximal (p=0.467). In distal occlusions, successful recanalization was an independent predictor of good outcome (adjusted odds ratio (aOR) 5.11, p<0.05) irrespective of technique. Younger age, bridging therapy, and lower admission National Institutes of Health Stroke Scale (NIHSS) were also predictors of good outcome. Procedure time ≤1 hour or ≤3 thrombectomy attempts were independent predictors of good outcomes in DVOs irrespective of technique (aOR 4.5 and 2.3, respectively, p<0.05). There were no differences in outcomes in a DVO matched cohort of aspiration versus stent retriever. Rates of hemorrhage and good outcome showed an exponential relationship to procedural metrics, and were more dependent on time in the aspiration group and attempts in the stent retriever group.Outcomes following EVT for DVO are comparable to LVO with similar results between techniques. Techniques may exhibit different futility metrics; stent retriever thrombectomy was influenced by attempts whereas aspiration was more dependent on procedure time.
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