Stent Expansion and In-Stent Thrombus Sign in the Trevo Stent Retriever Predict Recanalization and Possible Etiology During Mechanical Thrombectomy: A Case Series of 50 Patients with Acute Middle Cerebral Artery Occlusion
Stent Expansion and In-Stent Thrombus Sign in the Trevo Stent Retriever Predict Recanalization and Possible Etiology During Mechanical Thrombectomy: A Case Series of 50 Patients with Acute Middle Cerebral Artery Occlusion
复制标题
DOI：
10.1016/j.wneu.2018.12.087
复制
发表时间：
2019-04-01
影响因子：
2
通讯作者：
Kohmura, Eiji
中科院分区：
文献类型：
--
作者：
Imahori, Taichiro;Okamura, Yusuke;Kohmura, Eiji
背景：支架回收器与血栓之间的相互作用是机械取栓过程中血栓再通的关键因素。本研究的目的是评估血栓切除术期间放射学上明显的特征与使用完全不透射线支架的Trevo支架回收器的血管造影结果之间的关系。方法：我们回顾性分析了50例急性大脑中动脉闭塞患者使用Trevo治疗。患者被分为两组，一组达到（首通再通组，n = 21）或未达到（非首通再通组，n = 29）改良脑缺血溶栓评分为2b或3。根据闭塞病因将患者分为血栓栓塞组（n = 39）和动脉粥样硬化组（n = 11）。我们评估了第一次手术中Trevo支架的影像学表现（例如支架扩张程度和支架内血栓充盈缺陷[支架内血栓征象]）。结果：首次通道再通组支架扩张中位数明显大于非首次通道再通组（60% vs. 34%, P < 0.01），血栓栓塞组支架扩张中位数明显大于动脉粥样硬化组（45% vs. 31%, P < 0.01）。受体操作者特征曲线对再通和病因的预测能力中等，曲线下面积分别为0.83和0.73。血栓栓塞组支架内血栓征象明显高于动脉粥样硬化组（86% vs. 10%; P < 0.01）。结论：较大的支架扩张与血栓切除术后再通相关。支架内血栓征象可能有助于病因预测。这些影像学结果可以在手术过程中提供有用的实时反馈，反映血栓与支架的相互作用。
BACKGROUND: Interaction between the stent retriever and clot is a key factor for recanalization during mechanical thrombectomy. The aim of this study was to evaluate the association between radiographically apparent features during thrombectomy and angiographic outcomes using the Trevo stent retriever with a fully radiopaque strut.METHODS: We retrospectively reviewed 50 patients with acute middle cerebral artery occlusion who were treated with the Trevo. Patients were divided into groups that achieved (first-pass recanalization group, n = 21) or did not achieve (non-first-pass recanalization group, n = 29) a modified Thrombolysis in Cerebral Ischemia score of 2b or 3 with the first-pass procedure. Patients were also divided into a thromboembolic (n = 39) and atherosclerotic (n = 11) group by occlusion etiology. We evaluated radiographic findings of the Trevo's strut (e.g., degree of stent expansion and filling defect of the thrombus in the strut [in-stent thrombus sign]) during the first-pass procedure.RESULTS: Median stent expansion was significantly greater in the first-pass recanalization group than in the non-first-pass recanalization group (60% vs. 34%; P < 0.01) and in the thromboembolic group than in the atherosclerotic group (45% vs. 31%; P < 0.01). The receiver operator characteristic curve showed moderate capacity for prediction of recanalization and etiology, with an area under the curve of 0.83 and 0.73, respectively. In-stent thrombus sign was significantly more common in the thromboembolic group than in the atherosclerotic group (86% vs. 10%; P < 0.01).CONCLUSIONS: Greater stent expansion was associated with recanalization after thrombectomy. The in-stent thrombus sign may be useful for etiology prediction. These radiographic findings could provide useful real-time feedback during procedures, reflecting clot-stent interaction.