잠시만 기다려 주세요. 로딩중입니다.

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

Journal of Korean Neurosurgical Society 2019년 62권 4호 p.405 ~ 413
 ( Kim Sang-Hwa ) - Dong-A University College of Medicine Dong-A University Hospital Department of Neurosurgery

 ( Choi Jae-Hyung ) - Dong-A University College of Medicine Dong-A University Hospital Department of Neurosurgery
 ( Kang Myung-Jin ) - Dong-A University College of Medicine Dong-A University Hospital Department of Radiology
 ( Cha Jae-Kwan ) - Dong-A University College of Medicine Dong-A University Hospital Department of Neurology
 ( Kim Dae-Hyun ) - Dong-A University College of Medicine Dong-A University Hospital Department of Neurology
 ( Nah Hyun-Wook ) - Dong-A University College of Medicine Dong-A University Hospital Department of Neurology
 ( Park Hyun-Seok ) - Dong-A University College of Medicine Dong-A University Hospital Department of Neurosurgery
 ( Kim Sang-Hyun ) - Dong-A University College of Medicine Dong-A University Hospital Department of Radiology
 ( Huh Jae-Taeck ) - Dong-A University College of Medicine Dong-A University Hospital Department of Neurosurgery

Abstract


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.

키워드

Stroke; Brain ischemia; Thrombectomy; Stents
원문 및 링크아웃 정보
  
등재저널 정보