Stent retriever導入後の急性内頚動脈閉塞に対する血栓再開通療法の治療成績

抄録

Objective: Recanalization rates and clinical outcomes of acute internal carotid artery (ICA) occlusion are less favorable than those of middle carotid artery (MCA) occlusion despite using IV recombinant tissue plasminogen activator (rt-PA) therapy or previous-generation thrombectomy devices. We report the treatment outcomes of endovascular reperfusion therapy for acute ICA occlusion after the introduction of stent retrievers (SR).

Methods: After the introduction of SR in our hospital, endovascular intervention for acute ICA occlusion was performed in 26 patients between June 2014 and January 2018. We retrospectively investigated the clinical results and compared them with those of 45 patients with MCA occlusion in same period and those of 11 patients with ICA occlusions before the introduction of SR.

Results: Various etiologies of ICA occlusion were noted in the patients, including atrial fibrillation in 17, myocardial infarction in 2, intracranial atherosclerosis in 2, pre-existing carotid artery stenosis in 3, ICA dissection in 1, and other in 1. Based on the clot morphology and functional collaterals, ICA occlusion were categorized as T or L occlusions in 17 patients and I occlusions in 9. The most effective device for reperfusion was SR in 12 patients, although application of a percutaneous transluminal angiography balloon catheter or an intracranial stent was needed in some cases. Two patients developed symptomatic intracerebral hemorrhage after SR thrombectomy. Successful reperfusion (Thrombolysis in Cerebral Infarction [TICI] 2b or 3) was achieved in 24 patients (92%) in the ICA occlusion group and 37 patients (82%) in the M1 occlusion group. A favorable functional outcome (modified Rankin Scale [mRS] score of 0-2) at discharge was achieved in 13 patients (50%) in the ICA occlusion group and 14 patients (31%) in the M1 occlusion group. No significant differences in recanalization rates (TICI 2b, 3) and good outcomes (mRS scores of 0-2) were found between the ICA and M1 occlusion groups. The rate of successful reperfusion and favorable functional outcomes in patients after the introduction of SR were significantly higher than those reported before the introduction of SR (p = 0.0009 and 0.003, respectively).

Conclusion: The selection of appropriate devices and techniques, including SR thrombectomy, according to stroke etiology has contributed to high rates of successful reperfusion and good functional outcomes in patients with acute ICA occlusion.