Abstract：
BACKGROUND: Mechanical thrombectomy (MT) is part of the standard of care for stroke treatment, and improving its efficacy is one of the main objectives of clinical investigation. Of importance is placement of the distal end of balloon-guided catheters (BGC). We aim to determine if this influences outcomes.
METHODS: We analyzed data from the ASSIST Registry, an international, multicenter prospective study of 1492 patients. We divided patients treated with BGC according to the placement of the BGC: low cervical (LCG (the lower 2/3 of cervical internal carotid artery (ICA)) or high cervical (HCG (upper 1/3 of cervical ICA, petro-lacerum or higher)). We analyzed characteristics and outcomes overall and stratified on the primary MT technique: Stent-Retriever only (SR Classic), Combined use of aspiration catheter and SR (Combined), and Direct Aspiration (ADAPT).
RESULTS: Our study included 704 subjects -323 in the low cervical and 381 in the high cervical groups. Statistical differences were seen in the proportion of females and tandem lesions (both higher for LCG). Placing the BGC in the high cervical segment is associated with better recanalization rates (expanded treatment in cerebral infarction (eTICI) score of 2c-3) at the end of the procedure (P<0.0001) and shorter procedures (P=0.0005). After stratifying on the three primary techniques (SR Classic, Combined, and ADAPT), placing the BGC in the high segment is associated with a better first-pass effect (FPE), less distal emboli, and better clinical outcomes in the SR Classic technique.
CONCLUSIONS: Placing the distal end of the BGC at the high cervical segment or higher is associated with better recanalization.
METHODS: We analyzed data from the ASSIST Registry, an international, multicenter prospective study of 1492 patients. We divided patients treated with BGC according to the placement of the BGC: low cervical (LCG (the lower 2/3 of cervical internal carotid artery (ICA)) or high cervical (HCG (upper 1/3 of cervical ICA, petro-lacerum or higher)). We analyzed characteristics and outcomes overall and stratified on the primary MT technique: Stent-Retriever only (SR Classic), Combined use of aspiration catheter and SR (Combined), and Direct Aspiration (ADAPT).
RESULTS: Our study included 704 subjects -323 in the low cervical and 381 in the high cervical groups. Statistical differences were seen in the proportion of females and tandem lesions (both higher for LCG). Placing the BGC in the high cervical segment is associated with better recanalization rates (expanded treatment in cerebral infarction (eTICI) score of 2c-3) at the end of the procedure (P<0.0001) and shorter procedures (P=0.0005). After stratifying on the three primary techniques (SR Classic, Combined, and ADAPT), placing the BGC in the high segment is associated with a better first-pass effect (FPE), less distal emboli, and better clinical outcomes in the SR Classic technique.
CONCLUSIONS: Placing the distal end of the BGC at the high cervical segment or higher is associated with better recanalization.
摘要：
背景：机械血栓切除术（MT）是中风治疗护理标准的一部分，提高其疗效是临床研究的主要目标之一。重要的是放置球囊引导导管(BGC)的远端。我们的目标是确定这是否会影响结果。
方法：我们分析了来自ASSIST注册中心的数据，一个国际,1492例患者的多中心前瞻性研究。我们根据BGC的放置将接受BGC治疗的患者分为：宫颈低位（LCG（颈内动脉（ICA）的下2/3）或宫颈高位（HCG（宫颈ICA的上1/3，Petro-lacerum或更高））。我们分析了主要MT技术的总体特征和结果，并对其进行了分层：仅支架式检索器(SRClassic)，联合使用抽吸导管和SR（联合），和直接抽吸（ADAPT）。
结果：我们的研究包括704名受试者，低宫颈组-323名，高宫颈组-381名。女性和串联病变的比例存在统计学差异（LCG均较高）。在手术结束时（P<0.0001）和较短的手术（P=0.0005），将BGC置于高颈段与较好的再通率（扩大的脑梗死（eTICI）评分为2c-3）相关。在对三种主要技术(SRClassic，合并,和适应），将BGC放在高段与更好的首传效果(FPE)相关，远端栓塞较少，和更好的临床结果在SR经典技术。
结论：将BGC的远端置于宫颈高段或更高段与更好的再通相关。
方法：我们分析了来自ASSIST注册中心的数据，一个国际,1492例患者的多中心前瞻性研究。我们根据BGC的放置将接受BGC治疗的患者分为：宫颈低位（LCG（颈内动脉（ICA）的下2/3）或宫颈高位（HCG（宫颈ICA的上1/3，Petro-lacerum或更高））。我们分析了主要MT技术的总体特征和结果，并对其进行了分层：仅支架式检索器(SRClassic)，联合使用抽吸导管和SR（联合），和直接抽吸（ADAPT）。
结果：我们的研究包括704名受试者，低宫颈组-323名，高宫颈组-381名。女性和串联病变的比例存在统计学差异（LCG均较高）。在手术结束时（P<0.0001）和较短的手术（P=0.0005），将BGC置于高颈段与较好的再通率（扩大的脑梗死（eTICI）评分为2c-3）相关。在对三种主要技术(SRClassic，合并,和适应），将BGC放在高段与更好的首传效果(FPE)相关，远端栓塞较少，和更好的临床结果在SR经典技术。
结论：将BGC的远端置于宫颈高段或更高段与更好的再通相关。
