Mechanical thrombectomy of intracranial internal carotid occlusion - Pooled results of the MERCI and multi MERCI part I trials
Mechanical thrombectomy of intracranial internal carotid occlusion - Pooled results of the MERCI and multi MERCI part I trials
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DOI：
10.1161/01.str.0000260187.33864.a7
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发表时间：
2007-04-01
期刊：
影响因子：
8.3
通讯作者：
Smith, Wade S.
中科院分区：
文献类型：
--
作者：
Flint, Alexander C.;Duckwiler, Gary R.;Smith, Wade S.
颅内内部动脉（ICA）的闭塞的背景和目的急性中风通常的预后较差，并且似乎对静脉内溶栓的反应较差。机械血栓切除术是用于急性中风疗法的新近可用的方式，但是尚不清楚这种血管内治疗是否可能在颅内ICA闭塞的特定环境中起作用。因此，我们评估了MERCI回收者机械性血栓切除术在重新定性的颅内ICA闭塞过程中的成功率，并试图确定ICA对这种疗法的重新加续化是否可以导致更好的结局 - 所有的结果 - 所有来自颅内ICA的急性中风的患者在颅内ICA闭塞的患者中得到了识别。 Merci和多Merci第一部分试验。我们确定了ICA重新定性对血管内血栓切除术的成功率，然后根据是否成功评估血管的临床结局。鉴定出颅内ICA闭塞的急性中风的急诊症患者。在这80名患者中，仅使用Merci猎犬获得了成功的ICA重新续签，而63％的患者则使用Merci Retriever以及辅助性内血管内治疗进行了ICA重新加固。基线患者特征和程序并发症之间没有差异。良好的临床结局是由39％的ICA再持续化患者（49个中的n = 19）和3％的没有ICA再持CANICA重新加固的患者（n = 1中的n = 1，30）患者（n = 1 ef 30），良好的兰金级量表为0至2，在90天（90天）发生了。 （p <0.001；一名患者丢失了为90天修改的Rankin量表的随访）。在重新加拿大的组中，九十天的死亡率为30％（n = 50中的n = 15个），非记权组的73％（n = 22中的n = 22）（p <0.001）。症状出血之间没有显着差异（6％[n = 3 of 50]）和非记录的（16.7％[30]）组（p = 0.14）。还没有发现出血率受到机械血栓切除术前静脉溶栓的影响。多变量逻辑回归鉴定出ICA的重新定性（OR = 28.4，95％CI = 2.6至> 99.9）和缺乏高血压史（OR = 0.15，95％CI = 0.04至0.57）是一个很好的90天结果的重要预测指标。未能重新启动ICA（OR = 0.16，95％CI = 0.05至0.51）和年龄（每十年，OR = 1.07，95％CI = 1.03至1.13）是90天死亡率的重要预测指标。急性颅内ICA闭塞使用Merci猎犬装置，单独或与辅助内血管内治疗相结合成功的船舶再通行率很高。与ICA未能成功重新加固的受试者相比，通过这种方法成功地进行ICA重新定性的受试者改善了中风后临床结局和存活率。
Background and Purpose-Acute stroke from occlusion of the intracranial internal carotid artery (ICA) generally has a poor prognosis and appears to respond poorly to intravenous thrombolysis. Mechanical thrombectomy is a newly available modality for acute stroke therapy, but it is unknown whether this endovascular therapy may have a role in the specific setting of intracranial ICA occlusion. We therefore assessed the success rate of the Merci Retriever mechanical thrombectomy device in recanalization of intracranial ICA occlusions and sought to determine whether ICA recanalization with this therapy can result in better outcomes.Methods-All patients with acute stroke from intracranial ICA occlusion were identified in the MERCI and Multi MERCI Part I trials. We determined the success rate of ICA recanalization with endovascular thrombectomy and then assessed clinical outcomes according to whether vessel recanalization was successful.Results-Eighty patients with acute stroke from intracranial ICA occlusion were identified. Of these 80 patients, 53% had successful ICA recanalization with the Merci Retriever alone and 63% had ICA recanalization with use of the Merci Retriever plus adjunctive endovascular treatment. Baseline patient characteristics and procedural complications did not differ between the recanalized and nonrecanalized groups. Good clinical outcome, defined by a modified Rankin Scale of 0 to 2 at 90 days, occurred in 39% of patients with ICA recanalization (n = 19 of 49) and in 3% of patients without ICA recanalization (n = 1 of 30) (P < 0.001; one patient was lost to follow up for 90-day modified Rankin Scale). Ninety-day mortality was 30% (n = 15 of 50) in the recanalized group and 73% (n = 22 of 30) in the nonrecanalized group (P < 0.001). Symptomatic hemorrhage was not significantly different between the recanalized (6% [n = 3 of 50]) and nonrecanalized (16.7% [n = 5 of 30]) groups (P = 0.14). Hemorrhage rates were also not found to be influenced by use of intravenous thrombolysis before mechanical thrombectomy. Multivariable logistic regression identified ICA recanalization (OR = 28.4, 95% CI = 2.6 to > 99.9) and lack of history of hypertension (OR = 0.15, 95% CI = 0.04 to 0.57) as significant predictors of a good 90-day outcome. Failure to recanalize the ICA (OR = 0.16, 95% CI = 0.05 to 0.51) and age (per decade, OR = 1.07, 95% CI = 1.03 to 1.13) were significant predictors of mortality at 90 days.Conclusions-Mechanical thrombectomy of acute intracranial ICA occlusion using the Merci Retriever device, alone or in combination with adjunctive endovascular therapy, has a high rate of successful vessel recanalization. Subjects with successful ICA recanalization by this method have improved poststroke clinical outcome and survival compared with subjects in which the ICA is not successfully recanalized.