Efficacy of mechanical thrombectomy with stent-retriever for anterior circulation distal vessel occlusion / 第二军医大学学报

ABSTRACT

Objective To explore the therapeutic effect of mechanical thrombectomy with stent-retriever for the anterior circulation distal vessel occlusion. Methods Consecutive cases with anterior circulation distal vessel occlusion treated with mechanical thrombectomy in Stroke Center of Changhai Hospital of Navy Medical University (Second Military Medical University) from Sep. 2013 to May 2018 were enrolled. According to whether undergoing intravenous thrombolysis, the patients were divided into bridging group and direct thrombectomy group. The primary outcome was the neurological functional prognosis at 90 d after operation measured with modified Rankin Scale (mRS, mRS score≤2 reflected good prognosis). The secondary outcomes were the rate of recanalization (modified thrombolysis in cerebral ischemia [mTICI] grade≥2b), the National Institutes of Health stroke scale (NIHSS) score at 24 h after operation, complications and mortality. Results Totally 36 patients aged (68.3±13.6) years (ranging from 26 to 88 years) were included. There were 27 cases with middle cerebral artery (MCA) M2 segment occlusion, 5 cases with anterior cerebral artery (ACA) A1/A2 segment occlusion and 4 cases with MCA M2 segment accompanied with ACA A2 segment occlusion. The rate of recanalization of the occluded distal vessels was 91.7% (33/36) after mechanical thrombectomy with stent-retriever. The rate of good prognosis at 90 d after operation was 52.8% (19/36). The most common complication was vasospasm (33.3%, 12/36), followed by hemorrhagic transformation (16.7%, 6/36). The incidence of symptomatic intracranial hemorrhage was 5.6% (2/36) and the mortality was 8.3% (3/36). There were 14 cases in the brigding group and 22 cases in the direct thrombectomy group. The preoperative NIHSS score of the bridging group was significantly higher than that of the direct thrombectomy group (Z=3.025, P=0.002). While there were no significant differences in the NIHSS score at 24 h after operation, times of thrombectomy, the rate of recanalization, the rate of good prognosis at 90 d after operation, the incidence of hemorrhagic transformation or mortality between the bridging group and the direct thrombetomy group (all P>0.05). Conclusion The mechanical thrombectomy with stent-retriever for the anterior circulation distal vessel occlusion is likely safe and effective, and it is beneficial for vascular recanalization and good outcomes at 90 d.