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학제간연구 과학기술학 뇌인지과학 기술정책 기타 복합학

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학술저널
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Choi, Jae-Hyung (Department of Neurosurgery, Busan-Ulsan Regional Cardiocerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University) Park, Hyun-Seok (Department of Neurosurgery, Busan-Ulsan Regional Cardiocerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University) Kim, Dae-Hyun (Department of Neurology, Busan-Ulsan Regional Cardiocerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University) Cha, Jae-Kwan (Department of Neurology, Busan-Ulsan Regional Cardiocerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University) Huh, Jae-Taeck (Department of Neurosurgery, Busan-Ulsan Regional Cardiocerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University) Kang, Myongjin (Department of Diagnostic Radiology, Busan-Ulsan Regional Cardiocerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University)
저널정보
대한신경외과학회 대한신경외과학회지 대한신경외과학회지 제57권 제5호
발행연도
2015.1
수록면
342 - 349 (8page)

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Background : Higher reperfusion rates have been established with endovascular treatment for acute ischemic stroke patients. There are limited data on the comparative performance of mechanical thrombectomy devices. This study aimed to analyse the efficacy and safety of the stent retriever device (Solitaire stent) by comparing procedure time, angiographic outcome, complication rate and long term clinical outcome with previous chemical thrombolysis and mechanical thrombectomy using penumbra system. Method : A retrospective single-center analysis was undertaken of all consecutive patients who underwent chemical thrombolysis and mechanical thrombectomy using Penumbra or Solitaire stent retriever from March 2009 to March 2014. Baseline characteristics, rate of successful recanalization (modified Thrombolysis in Cerebral Infarction score 2b-3), symptomatic intracerebral hemorrhage, procedure time, mortality and independent functional outcomes ($mRS{\leq}2$) at 3 month were compared across the three method. Results : Our cohort included 164 patients, mechanical thrombectomy using stent retriever device had a significant impact on recanalization rate and functional independence at 3 months. In unadjusted analysis mechanical thrombectomy using Solitaire stent retriever showed higher recanalization rate than Penumbra system and chemical thrombolysis (75% vs. 64.2% vs. 49.4%, p=0.03) and higher rate of functional independence at 3 month (53.1% vs. 37.7% vs. 35.4%, p=0.213). In view of the interrelationships between all predictors of variables associated with a good clinical outcome, when the chemical thrombolysis was used as a reference, in multiple logistic regression analysis, the use of Solitaire stent retriever showed higher odds of independent functional outcome [odds ratio (OR) 2.62, 95% confidence interval (CI) 0.96-7.17; p=0.061] in comparison with penumbra system (OR 1.57, 95% CI 0.63-3.90; p=0.331). Conclusion : Our initial data suggest that mechanical thrombectomy using stent retriever is superior to the mechanical thrombectomy using penumbra system and conventional chemical thrombolysis in achieving higher rates of reperfusion and better outcomes. Randomized clinical trials are needed to establish the actual benefit to specific patient populations.
#Acute ischemic stroke #Thrombectomy #Thrombolysis

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참고문헌 (22)

참고문헌 신청
Adams HP Jr. / 2007 / Guidelines for the early management of adults with ischemic stroke : a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups : the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists / Stroke 38:1655~1711 google schola Chueh JY. / 2012 / Effectiveness of mechanical endovascular thrombectomy in a model system of cerebrovascular occlusion / AJNR Am J Neuroradiol 33:1998~2003 google schola Derex L. / 2002 / Early detection of cerebral arterial occlusion on magnetic resonance angiography : predictive value of the baseline NIHSS score and impact on neurological outcome / Cerebrovasc Dis 13:225~229 google schola Fields JD. / 2011 / Higher degrees of recanalization after mechanical thrombectomy for acute stroke are associated with improved outcome and decreased mortality : pooled analysis of the MERCI and Multi MERCI trials / AJNR Am J Neuroradiol 32:2170~2174 google schola Furlan A. / 1999 / Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study : a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism / JAMA 282:2003~2011 google schola

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