Efficacy of Combining Proximal Balloon Guiding Catheter and Distal Access Catheter in Thrombectomy with Stent Retriever for Anterior Circulation Ischemic Stroke.

Autor: Kim SH; Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea.; Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea., Choi JH; Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea.; Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea., Kang MJ; Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea.; Department of Radiology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea., Cha JK; Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea.; Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea., Kim DH; Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea.; Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea., Nah HW; Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea.; Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea., Park HS; Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea.; Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea., Kim SH; Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea.; Department of Radiology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea., Huh JT; Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea.; Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea.
Jazyk: angličtina
Zdroj: Journal of Korean Neurosurgical Society [J Korean Neurosurg Soc] 2019 Jul; Vol. 62 (4), pp. 405-413. Date of Electronic Publication: 2019 Jul 01.
DOI: 10.3340/jkns.2019.0007
Abstrakt: Objective: We evaluated efficacy of combining proximal balloon guiding catheter (antegrade flow arrest) and distal access catheter (aspiration at the site of occlusion) in thrombectomy for anterior circulation ischemic stroke.
Methods: We retrospectively analyzed 116 patients who underwent mechanical thrombectomy with stent retriever. The patients were divided by the techniques adopted, the combined technique (proximal balloon guiding catheter and large bore distal access catheter) group (n=57, 49.1%) and the conventional (guiding catheter with stent retriever) technique group (n=59, 50.9%). We evaluated baseline characteristics (epidemiologic data, clinical and imaging characteristics) and procedure details (the number of retrieval attempts, procedure time), as well as angiographic (thrombolysis in cerebral infarction (TICI) score, distal thrombus migration) and clinical outcome (National Institutes of Health Stroke Scale at discharge, modified Rankin Scale [mRS] at 3 months) of them.
Results: The number of retrieval attempts was lower (p=0.002) and the first-pass successful reperfusion rate was higher (56.1% vs. 28.8%; p=0.003) in the combined technique group. And the rate of final result of TICI score 3 was higher (68.4% vs. 28.8%; p<0.01) and distal thrombus migration rate was also lower (15.8% vs. 40.7%; p=0.021) in the combined technique group. Early strong neurologic improvement (improvement of National Institutes of Health Stroke Scale ≥11 or National Institutes of Health Stroke Scale ≤1 at discharge) rate (57.9% vs. 36.2%; p=0.02) and favorable clinical outcome (mRS at 3 months ≤2) rate (59.6% vs. 33.9%; p=0.005) were also better in the combined technique group.
Conclusion: The combined technique needs lesser attempts, decreases distal migration, increases TICI 3 reperfusion and achieves better clinical outcomes.
Databáze: MEDLINE
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