Microemboli After Successful Thrombectomy Do Not Affect Outcome but Predict New Embolic Events
Microemboli After Successful Thrombectomy Do Not Affect Outcome but Predict New Embolic Events
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DOI：
10.1161/strokeaha.119.025856
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发表时间：
2020-01-01
期刊：
影响因子：
8.3
通讯作者：
Castro, Pedro
中科院分区：
文献类型：
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作者：
Sheriff, Faheem;Diz-Lopes, Mariana;Castro, Pedro
背景和目的：我们旨在确定血管内取栓后的微栓塞是否与成功再通后的不良结果相关。方法：这是一项前瞻性多中心研究，对成功取栓后连续发生前循环血管闭塞（颈内动脉末端或大脑中动脉主干/大脑中动脉段大脑中动脉主干一级分支）的缺血性卒中患者进行研究（脑缺血改良治疗分级2b-3）。微栓塞信号（MES）在最后一次见井后72小时内通过30分钟经颅多普勒监测进行评估。主要结果包括90天时修改的Rankin量表和24小时时头部计算机断层扫描的梗死体积。我们还根据美国国立卫生研究院卒中量表的变化和90天内卒中复发、短暂性脑缺血发作或全身性栓塞的早期结果进行了评估。结果：在111例患者中，43例（39%）检测到MES，中位率为4次/小时（四分位数范围2-12）。MES的发生与修正Rankin量表（序移分析，校正优势比1.06 [95% CI, 0.48-2.34] P=0.85）和功能独立性（修正Rankin量表，0-2：校正优势比0.52 [95% CI, 0.19-1.39] P=0.19）无显著性差异。24小时计算机断层扫描显示，有和没有MES的患者梗死体积相似（校正β值，11.2 [95% CI, -46.6至+22.9]P=0.51）。MES确实预测了新的栓塞事件（校正Cox风险比为6.78 [95% CI, 1.63-27.8] P=0.01）。结论：血管内治疗前循环闭塞后经颅多普勒检测MES不能预测临床或放射学结果。然而，这种栓塞是90天内复发性栓塞事件的独立标志。
Background and Purpose- We aimed to determine if microemboli after endovascular thrombectomy correlate with unfavorable outcomes despite successful recanalization. Methods- This is a prospective multicenter study of consecutive patients with ischemic stroke and occlusion of anterior circulation vessels (terminal internal carotid or main trunk of the middle cerebral artery/first-order branch of the main trunk of the middle cerebral artery segments of middle cerebral artery) after successful thrombectomy (modified Treatment In Cerebral Ischemia grades 2b-3). Microembolic signals (MES) were assessed by 30 minutes of transcranial Doppler monitoring within 72 hours of the last-seen-well time. Major outcomes included modified Rankin Scale at 90 days and infarct volume on head computed tomography at 24 hours. We also assessed early outcomes based on National Institutes of Health Stroke Scale variation and recurrence of stroke, transient ischemic attack, or systemic embolism within 90 days. Results- Among 111 patients, MES were detected in 43 (39%), with a median rate of 4 counts/h (interquartile range 2-12). The occurrence of MES was not associated with a significant difference in modified Rankin Scale (ordinal shift analysis, adjusted odds ratio, 1.06 [95% CI, 0.48-2.34] P=0.85) nor in functional independence (modified Rankin Scale, 0-2: adjusted odds ratio, 0.52 [95% CI, 0.19-1.39] P=0.19). Patients with and without MES had similar infarct volumes (adjusted beta, 11.2 [95% CI, -46.6 to +22.9] P=0.51) on 24-hour computed tomography. MES did predict new embolic events (adjusted Cox hazard ratio, 6.78 [95% CI, 1.63-27.8] P=0.01). Conclusions- MES detected by transcranial Doppler following endovascular treatment of anterior circulation occlusions do not predict clinical or radiological outcome. However, such emboli are an independent marker of recurrent embolic events within 90 days.