Endovascular Treatment for Acute Ischaemic Stroke due to Large-vessel Occlusion: Single-centre Experience
DCW Tang, CY Chu, R Li, SWH Cheng, RYT Ng, JCH Tse, AYT Lai, THT Sung, KYK Tang, WKW Leung, JLS Khoo
Hong Kong J Radiol 2018;21:7-15
DOI: 10.12809/hkjr1716881
Objectives: To evaluate the effectiveness of endovascular treatment (EVT) for acute ischaemic stroke in terms of angiographic results and clinical outcomes.
Methods: Patients who presented with symptoms of acute ischaemic stroke and who underwent EVT including mechanical thrombectomy and/or intra-arterial thrombolysis (IAT) at an acute-care public hospital between January 2013 and October 2016 were recruited. Digital angiographic images were reviewed by an independent neuroradiologist, who assigned a Thrombolysis in Cerebral Infarction (TICI) grade to each patient. Medical records were reviewed to retrieve the National Institutes of Health Stroke Scale score, modified Rankin scale (mRS) score at 90 days, and clinical outcomes.
Results: Records of a total of 38 patients were reviewed (mean age, 65.6 years). In all, 19 patients were treated with aspiration thrombectomy alone, 11 with both stent retriever and aspiration thrombectomy, six with stent-retriever thrombectomy alone, one with aspiration thrombectomy and IAT, and one with IAT alone. Revascularisation was successful (TICI grade 2b/3) in 76% of patients. The median time to reperfusion from the start of the procedure was 1 hour 3 minutes. Post-procedural symptomatic intracranial haemorrhage occurred in 11% of patients. Outcome was good (mRS score ≤ 2) and fair (mRS score ≤ 3) at 90 days in 27% and 43% of patients, respectively. The mean length of hospital stay for patients with successful and unsuccessful revascularisation was 35.7 and 62.3 days, respectively. The mortality rate within 90 days of EVT was 8%.
Conclusion: Our study shows that EVT has a high success rate for recanalisation, overall patient clinical outcomes are acceptable, and the procedure-related complication and mortality rates are low.
中文摘要
大血管閉塞導致急性缺血性中風的血管內介入治療：單一中心經驗
鄧峻樺、朱志揚、李梓強、鄭永豪、吳婉婷、謝志瀚、黎爾德、宋咸東、鄧業勤、梁錦榮、邱麗珊
目的：根據血管造影結果和臨床結果，評估血管內介入（EVT）治療急性缺血性中風的成效。
方法：納入2013年1月至2016年10月期間，在一間公立急症醫院接受EVT，包括機械性血栓切除術及／或動脈內溶栓治療（IAT）的急性缺血性中風症狀患者。數碼血管造影圖像由獨立神經放射學專家審查，並為每位患者的腦梗塞溶栓等級（TICI）評分，同時核對醫療記錄中的美國國家衛生研究院腦中風量表（NIHSS）和90天改良Rankin量表（mRS）評分以及臨床結果。
結果：本研究包括38例患者（平均年齡65.6歲）。19例患者接受抽吸去栓術、11例使用支架取栓術加抽吸去栓術、6例使用支架取栓術、1例使用抽吸去栓術和IAT，以及1例使用IAT。血管重新灌流的成功率（即TICI評級為2b/3）為76%。由開始手術到再灌流治療的中位時間為1小時3分鐘。術後有症狀的顱內出血發生率為11%。90天時獲得良好結果（mRS得分≤2）和一般結果（mRS得分≤3）分別達27%和43%。血管重新灌流成功和不成功的患者平均住院時間分別為35.7天和62.3天。EVT 90天內的死亡率為8%。
結論：研究結果顯示EVT令血管再通治療的成功率高。患者的整體臨床結果在可接受水平，與手術相關的併發症和死亡率也較低。