Comparison between transradial and transfemoral mechanical thrombectomy for ICA and M1 occlusions: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR).
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Silva Michael A, Elawady Sameh Samir, Maier Ilko, Al Kasab Sami, Jabbour Pascal, Kim Joon-Tae, Wolfe Stacey Q, Rai Ansaar, Psychogios Marios-Nikos, Samaniego Edgar A, Goyal Nitin, Yoshimura Shinichi, Cuellar Hugo, Grossberg Jonathan A, Alawieh Ali, Alaraj Ali, Ezzeldin Mohamad, Romano Daniele G, Tanweer Omar, Mascitelli Justin, Fragata Isabel, Polifka Adam J, Siddiqui Fazeel M, Osbun Joshua W, Crosa Roberto Javier, Matouk Charles, Levitt Michael R, Brinjikji Waleed, Moss Mark, Dumont Travis M, Williamson Richard, Navia Pedro, Kan Peter, De Leacy Reade Andrew, Chowdhry Shakeel A, Spiotta Alejandro M, Park Min S, Starke Robert M, STAR Collaborators
Аннотация
METHODS: The prospectively maintained Stroke Thrombectomy and Aneurysm Registry (STAR) was reviewed for patients who underwent mechanical thrombectomy for an internal carotid artery (ICA) or middle cerebral artery M1 occlusion. Multivariate regression analyses were performed to assess outcomes including reperfusion time, symptomatic intracerebral hemorrhage (ICH), distal embolization, and functional outcomes.
RESULTS: A total of 2258 cases, 1976 via the transfemoral approach and 282 via the transradial approach, were included. Radial access was associated with shorter reperfusion time (34.1 min vs 43.6 min, P=0.001) with similar rates of Thrombolysis in Cerebral Infarction (TICI) 2B or greater reperfusion (87.9% vs 88.1%, P=0.246). Patients treated via a transradial approach were more likely to achieve at least TICI 2C (59.6% vs 54.7%, P=0.001) and TICI 3 reperfusion (50.0% vs 46.2%, P=0.001), and had shorter lengths of stay (mean 9.2 days vs 10.2, P<0.001). Patients treated transradially had a lower rate of symptomatic ICH (8.0% vs 9.4%, P=0.047) but a higher rate of distal embolization (23.0% vs 7.1%, P<0.001). There were no significant differences in functional outcome at 90 days between the two groups.
CONCLUSIONS: Radial and femoral thrombectomy resulted in similar clinical outcomes. In multivariate analysis, the radial approach had improved revascularization rates, fewer cases of symptomatic ICH, and faster reperfusion times, but higher rates of distal emboli. Further studies on the optimal approach are necessary based on patient and disease characteristics.