Mechanical thrombectomy for acute tandem occlusion of anterior circulation

doi:10.3877/cma.j.issn.2095-5782.2020.04.008

Abstract

Abstract:

Objective

To analyze the efficacy of mechanical thrombectomy for acute tandem occlusion of anterior circulation.

Method

9 patients with acute tandem occlusion of anterior circulation received endovascular treatment, including Solitaire-based thrombectomy and angioplasty/stenting for patients with severe internal artery stenosis. Recanalization rate and procedural complications were retrospectively analyzed. Modified Rankin score was used for independence evaluation 3 months post operation.

Results

Immediate successful recanalization rate was 89%, symptomatic intracranial hemorrhage rate was 11%. Good clinical outcome (mRS 0-2) was achieved in 33% 90 d later, and mortality after 90 days was 11%.

Conclusions

Endovascular treatment for selected patients with acute tandem occlusion of anterior circulation was safe and effective.

Key words: Anterior circulation, Tandem occlusion, Mechanical thrombectomy

Ke Li, Mingyi Wang, Guodong Zhang, Yongsheng Liu, Yongjian Liu, Feng Wang. Mechanical thrombectomy for acute tandem occlusion of anterior circulation[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2020, 08(04): 333-338.

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Figures/Tables 4

References 22

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参数		总计（n=9）
年龄[岁，±s ]		68（8.8）
男性		5（67）
NIHSS（M）		16
ASPECTS评分（M）		7
高血压病		4（44）
糖尿病		4（44）
吸烟		4（44）
房颤		1（11）
发病前抗栓用药		2（22）
远端病变位置
	颅内ICA	5（56）
	MCA-M1	3（33）
	M2	1（11）
发病机制
	动脉夹层	1（11）
	大动脉粥样硬化伴远端栓塞	8（89）

参数		总计（n=9）
年龄[岁，±s ]		68（8.8）
男性		5（67）
NIHSS（M）		16
ASPECTS评分（M）		7
高血压病		4（44）
糖尿病		4（44）
吸烟		4（44）
房颤		1（11）
发病前抗栓用药		2（22）
远端病变位置
	颅内ICA	5（56）
	MCA-M1	3（33）
	M2	1（11）
发病机制
	动脉夹层	1（11）
	大动脉粥样硬化伴远端栓塞	8（89）

参数		总计（n=9）
发病—治疗时间
	≤6 h	5（56）
	6～12 h	4（44）
	静脉桥接治疗	3（33）
	术中替罗非班应用	3（33）
侧支代偿
	ASITN/SIR 0～1	1（11）
	ASITN/SIR 2	8（89）
	Solitaire取栓	6（68）
	平均取栓次数	1.3
	颈动脉支架/球囊成形No.（%）	9（100）
	由远及近再通	6（67）
再通情况
	TICI 0～2a	1（11）
	TICI 2b～3	8（89）
股动脉穿刺—再通时间
	≤60 min	1（11）
	60～120 min	6（67）
	≥120 min	2（22）

参数		总计（n=9）
发病—治疗时间
	≤6 h	5（56）
	6～12 h	4（44）
	静脉桥接治疗	3（33）
	术中替罗非班应用	3（33）
侧支代偿
	ASITN/SIR 0～1	1（11）
	ASITN/SIR 2	8（89）
	Solitaire取栓	6（68）
	平均取栓次数	1.3
	颈动脉支架/球囊成形No.（%）	9（100）
	由远及近再通	6（67）
再通情况
	TICI 0～2a	1（11）
	TICI 2b～3	8（89）
股动脉穿刺—再通时间
	≤60 min	1（11）
	60～120 min	6（67）
	≥120 min	2（22）

作者及年份	例数	TICI≥2b（%）	mRS≤2（%）	死亡率（%）	症状性脑出血（%）
Grigoryan, 2016^[15]	100	88	42	20	6
Maurer, 2015^[9]	43	76.7	32.6	21	12
Cohen, 2015^[8]	24	79	76	23	0
Lockau, 2015^[16]	37	73	46	19	11
Lescher, 2015^[10]	39	64	36	10	10
Behme, 2015^[17]	170	77	36	19	9

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