Background and Purpose

Randomized controlled trials have challenged the assumption that reperfusion success after mechanical thrombectomy varies depending on the retrieval techniques applied; however, recent analyses have suggested that acute ischemic stroke (AIS) patients showing susceptibility vessel sign (SVS) may respond differently. We aimed to compare different stent retriever (SR)-based thrombectomy techniques with respect to interventional outcome parameters depending on SVS status.

Methods

We retrospectively reviewed 497 patients treated with SR-based thrombectomy for anterior circulation AIS. Imaging was conducted using a 1.5 T or 3 T magnetic resonance imaging (MRI) scanner. Logistic regression analyses were performed to test for the interaction of SVS status and first-line retrieval technique. Results are shown as percentages, total values or adjusted odds ratio (aOR) with 95% confidence intervals (CI).

Results

An SVS was present in 87.9% (n = 437) of patients. First-line SR thrombectomy was used to treat 293 patients, whereas 204 patients were treated with a combined approach (COA) of SR and distal aspiration. An additional balloon-guide catheter (BGC) was used in 273 SR-treated (93.2%) and 89 COA-treated (43.6%) patients. On logistic regression analysis, the interaction variable of SVS status and first-line retrieval technique was not associated with first-pass reperfusion (aOR 1.736, 95% CI 0.491–6.136; p = 0.392), overall reperfusion (aOR 3.173, 95% CI 0.752–13.387; p = 0.116), periinterventional complications, embolization into new territories, or symptomatic intracerebral hemorrhage. The use of BGC did not affect the results.

Conclusion

While previous analyses indicated that first-line SR thrombectomy may promise higher rates of reperfusion than contact aspiration in AIS patients with SVS, our data show no superiority of any particular SR-based retrieval technique regardless of SVS status.

中文翻译：

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有或没有易感血管征的急性缺血性卒中患者的基于支架的回收技术

 背景和目的

随机对照试验对机械血栓切除术后再灌注成功率因所采用的取出技术而异的假设提出了挑战。然而，最近的分析表明，表现出易感性血管征（SVS）的急性缺血性中风（AIS）患者可能会有不同的反应。我们的目的是根据 SVS 状态比较不同的基于支架取栓器 (SR) 的血栓切除技术的介入结果参数。

 方法

我们回顾性分析了 497 例接受基于 SR 的血栓切除术治疗前循环 AIS 的患者。使用 1.5 T 或 3 T 磁共振成像 (MRI) 扫描仪进行成像。进行逻辑回归分析来测试 SVS 状态和一线检索技术的相互作用。结果以百分比、总值或调整优势比 (aOR) 和 95% 置信区间 (CI) 形式显示。

 结果

87.9% ( n = 437) 的患者存在 SVS。一线 SR 血栓切除术用于治疗 293 名患者，而 204 名患者则采用 SR 和远端抽吸联合方法 (COA) 进行治疗。 273 名接受 SR 治疗的患者 (93.2%) 和 89 名接受 COA 治疗的患者 (43.6%) 使用了额外的球囊引导导管 (BGC)。在逻辑回归分析中，SVS 状态和一线检索技术的交互变量与首过再灌注（aOR 1.736，95% CI 0.491–6.136； p = 0.392）、总体再灌注（aOR 3.173，95% CI）无关。 0.752–13.387； p = 0.116)、围介入并发症、栓塞进入新区域或有症状的脑出血。 BGC的使用并不影响结果。

 结论

虽然之前的分析表明，对于患有 SVS 的 AIS 患者，一线 SR 血栓切除术可能比接触性抽吸术带来更高的再灌注率，但我们的数据显示，无论 SVS 状态如何，任何基于 SR 的特定取栓技术都没有优越性。