Risk of distal embolization with stent retriever thrombectomy and ADAPT.
Risk of distal embolization with stent retriever thrombectomy and ADAPT.
复制标题
远端栓塞的风险是用支架检索器血栓切除术和适应的风险。
DOI：
10.1136/neurintsurg-2014-011491
复制
发表时间：
2016-02
影响因子：
4.8
通讯作者：
Gounis MJ
中科院分区：
文献类型：
--
作者：
Chueh JY;Puri AS;Wakhloo AK;Gounis MJ
在缺血性卒中的血管内治疗中，支架取栓器的临床结局和实现的再通率存在差异。我们的假设是，栓塞微粒的手术释放可能是不良结局的一个促成因素，并且是一种可改变的风险。本研究的目的是评估降低远端栓塞风险的各种治疗策略。在具有侧支循环的血管体模中模拟机械血栓切除术。使用硬易碎片凝块（HFC）和软弹性凝块（SEC）产生大脑中动脉（MCA）闭塞，通过（1）8 Fr球囊导引导管（BGC），（2）MCA中凝块近端的5 Fr远端通路导管（Solumbra），或（3）头端位于颈颈内动脉的6 Fr导引导管（导引导管，GC），由Solitaire FR器械回收。 将机械血栓切除术的结果与使用Penumbra 5 MAX导管直接抽吸的结果进行比较。主要终点是栓子的大小分布与大脑中动脉和前动脉的分布。Solumbra是减少HFC片段的最有效方法（p<0.05），而BGC是防止SEC片段化的最佳方法（p<0.05）。使用GC时，形成HFC远端栓子（>1000 µm）的风险显著增加。在尺寸为50-1000 µm的几个栓子亚组中观察到直接抽吸的非统计学显著获益。 然而，与支架-取栓器机械血栓切除术技术相比，直接抽吸显著增加SEC碎片（<50 µm）的风险至少两倍。 远端栓塞的风险受导管插入技术和凝块力学的影响。
There is a discrepancy in clinical outcomes and the achieved recanalization rates with stent retrievers in the endovascular treatment of ischemic stroke. It is our hypothesis that procedural release of embolic particulate may be one contributor to poor outcomes and is a modifiable risk. The goal of this study is to assess various treatment strategies that reduce the risk of distal emboli. Mechanical thrombectomy was simulated in a vascular phantom with collateral circulation. Hard fragment-prone clots (HFC) and soft elastic clots (SECs) were used to generate middle cerebral artery (MCA) occlusions that were retrieved by the Solitaire FR devices through (1) an 8 Fr balloon guide catheter (BGC), (2) a 5 Fr distal access catheter at the proximal aspect of the clot in the MCA (Solumbra), or (3) a 6 Fr guide catheter with the tip at the cervical internal carotid artery (guide catheter, GC). Results from mechanical thrombectomy were compared with those from direct aspiration using the Penumbra 5MAX catheter. The primary endpoint was the size distribution of emboli to the distribution of the middle and anterior cerebral arteries. Solumbra was the most efficient method for reducing HFC fragments (p<0.05) while BGC was the best method for preventing SEC fragmentation (p<0.05). The risk of forming HFC distal emboli (>1000 µm) was significantly increased using GC. A non-statistically significant benefit of direct aspiration was observed in several subgroups of emboli with size 50–1000 µm. However, compared with the stent-retriever mechanical thrombectomy techniques, direct aspiration significantly increased the risk of SEC fragmentation (<50 µm) by at least twofold. The risk of distal embolization is affected by the catheterization technique and clot mechanics.