PDF(Pubmed)
Abstract：
OBJECTIVE: A higher reperfusion grade after endovascular thrombectomy (EVT) is associated with a good prognosis. However, the effect of the number of retrievals has not yet been investigated in vertebrobasilar occlusion (VBAO). Therefore, the aim of this study was to investigate whether to continue retrieval after early modified thrombolysis in cerebral infarction (mTICI) 2b to achieve a better reperfusion grade.
METHODS: We retrospectively analyzed the data of patients who underwent EVT caused by VBAO in a multicenter registry dataset. Patients who underwent successful reperfusion were included (mTICI 2b/3). Regression models were used to analyze the correlation of different reperfusion grades stratified by the number of retrieval attempts with clinical prognosis and hemorrhage transition.
RESULTS: We included 432 patients: 34.5% (n = 149) had a final mTICI score of 2b and 65.5% (n = 283) had a final mTICI score of 3. Patients who obtained a mTICI of 3 after the first pass had significantly increased odds of having a good prognosis. As the number of passes increases, the chances of obtaining a good prognosis decreases. After three or more passes, the odds of achieving functional independence and favorable outcomes were comparable to those of the first mTICI 2b, regardless of the 90-day (OR 1.132 95% CI 0.367-3.487 p = 0.829; OR 1.070 95% CI 0.375-3.047 p = 0.900) or 1-year follow-up (OR 1.217 95% CI 0.407-3.637 p = 0.725; OR 1.068 95% CI 0.359-3.173 p = 0.906).
CONCLUSIONS: Within two retrieval attempts, mTICI 3 was better than the first retrieval to mTICI 2b. After early mTICI 2b, each retrieval should be undertaken with caution to pursue a higher reperfusion grade.
METHODS: We retrospectively analyzed the data of patients who underwent EVT caused by VBAO in a multicenter registry dataset. Patients who underwent successful reperfusion were included (mTICI 2b/3). Regression models were used to analyze the correlation of different reperfusion grades stratified by the number of retrieval attempts with clinical prognosis and hemorrhage transition.
RESULTS: We included 432 patients: 34.5% (n = 149) had a final mTICI score of 2b and 65.5% (n = 283) had a final mTICI score of 3. Patients who obtained a mTICI of 3 after the first pass had significantly increased odds of having a good prognosis. As the number of passes increases, the chances of obtaining a good prognosis decreases. After three or more passes, the odds of achieving functional independence and favorable outcomes were comparable to those of the first mTICI 2b, regardless of the 90-day (OR 1.132 95% CI 0.367-3.487 p = 0.829; OR 1.070 95% CI 0.375-3.047 p = 0.900) or 1-year follow-up (OR 1.217 95% CI 0.407-3.637 p = 0.725; OR 1.068 95% CI 0.359-3.173 p = 0.906).
CONCLUSIONS: Within two retrieval attempts, mTICI 3 was better than the first retrieval to mTICI 2b. After early mTICI 2b, each retrieval should be undertaken with caution to pursue a higher reperfusion grade.
摘要：
目的：血管内血栓切除术（EVT）后较高的再灌注等级与良好的预后有关。然而,尚未在椎基底动脉闭塞（VBAO）中研究取回次数的影响。因此,这项研究的目的是研究是否在脑梗死早期改良溶栓(mTICI)2b后继续进行恢复,以达到更好的再灌注分级.
方法：我们回顾性分析了在多中心登记数据集中接受VBAO引起的EVT患者的数据。纳入成功再灌注的患者(mTICI2b/3)。采用回归模型分析不同再灌注等级与临床预后和出血过渡的相关性。
结果：我们纳入了432例患者：34.5%（n=149）的mTICI最终评分为2b，65.5%（n=283）的mTICI最终评分为3。首次通过后mTICI为3的患者具有良好预后的几率显着增加。随着通过次数的增加，获得良好预后的机会减少.经过三次或更多次，实现功能独立性和有利结果的几率与第一批mTICI2b相当，无论90天(OR1.13295%CI0.367-3.487p=0.829；OR1.07095%CI0.375-3.047p=0.900)或1年随访(OR1.21795%CI0.407-3.637p=0.725；OR1.06895%CI0.359-3.173p=0.906)。
结论：在两次检索尝试中，mTICI3优于首次检索到mTICI2b。早期mTICI2b后，每次检索都应谨慎进行,以追求更高的再灌注等级.
方法：我们回顾性分析了在多中心登记数据集中接受VBAO引起的EVT患者的数据。纳入成功再灌注的患者(mTICI2b/3)。采用回归模型分析不同再灌注等级与临床预后和出血过渡的相关性。
结果：我们纳入了432例患者：34.5%（n=149）的mTICI最终评分为2b，65.5%（n=283）的mTICI最终评分为3。首次通过后mTICI为3的患者具有良好预后的几率显着增加。随着通过次数的增加，获得良好预后的机会减少.经过三次或更多次，实现功能独立性和有利结果的几率与第一批mTICI2b相当，无论90天(OR1.13295%CI0.367-3.487p=0.829；OR1.07095%CI0.375-3.047p=0.900)或1年随访(OR1.21795%CI0.407-3.637p=0.725；OR1.06895%CI0.359-3.173p=0.906)。
结论：在两次检索尝试中，mTICI3优于首次检索到mTICI2b。早期mTICI2b后，每次检索都应谨慎进行,以追求更高的再灌注等级.
