抄録
Endovascular treatment is an emerging alternative for acute ischemic stroke. Recently, various endovascular approaches are being applied by using various devices. The aim of this study was to analyze technical and clinical results of patients with acute ischemic stroke treated for large intracranial vessel occlusion with endovascular procedure. The efficacy of mechanical thrombectomy using Merci Retriever and Penumbra System is evaluated.
Methods: We reviewed the clinical records of 55 consecutive patients who underwent endovascular treatment for acute ischemic stroke between October 2005 and September 2013. Mean patient age was 67 years (range 19-86); 75% were men. Median National Institutes of Health Stroke Scale at presentation was 20 (range 7-40). The occluded vessels were the internal carotid artery (ICA) in 21, middle cerebral artery (MCA) in 14, basilar artery in 17, and vertebral artery in 1 patient. Main endovascular procedure had shifted from intra-arterial thrombolysis and percutaneous transluminal angioplasty to mechanical thrombectomy since October 2010. Successful recanalization was defined as thrombolysis in cerebral infarction (TICI) grades 2b to 3. Good clinical outcome was defined as modified Rankin Scale (mRS) score of 0-2.
Results: Of the 55 patients, successful recanalization was achieved in 44% (24) of patients, and good clinical outcome at 3 months in 27% (15) patients. Procedure-related complication occurred in 9% (5/55) of patients. Subarachnoid hemorrhage due to vessel injury and symptomatic intracranial hemorrhage occurred in 7% (4/55) of patients each. One patient required surgery due to puncture site pseudo-aneurysm formation. Mortality was 15% (8/55) at 3 months. The introduction of mechanical thrombectomy was found to significantly reduce the procedure time. However, it was not significantly associated with successful recanalization and good clinical outcome. In the group of patients with ICA and proximal MCA occlusion, mechanical thrombectomy showed a tendency of good clinical outcome. Conclusion: Introduction of mechancical thrombectomy tends toward a favorable outcome among the patients with ICA and proximal MCA occlusion.
