A Comparison of Stent-Assisted Mechanical Thrombectomy and Conventional Intra-Arterial Thrombolysis for Acute Cerebral Infarction
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Background and Purpose We evaluated whether stent-assisted thrombectomy (SAT) is safer or more clinically beneficial than aggressive mechanical clot disruption (AMCD) for patients with acute intracranial artery occlusion. Methods We retrospectively analyzed the clinical data of 72 patients (33 with SAT and 39with AMCD) who underwent intra-arterial thrombolysis for acute intracranial artery occlusions. Procedure parameters, clinical outcomes, and incidence of complications were compared between the SAT and AMCD groups. Results The time interval to recanalization was shorter in SAT patients (69.2±39.6 minutes,mean±standard deviation) than in AMCD patients (94.4±48.0 minutes, p<0.05). Recanalization was achieved in more SAT patients (91%) than AMCD patients (80%), but with no statistically significance. Urokinase was used less frequently in SAT patients (21%) than in AMCD patients (92%, p<0.05), and the incidence of symptomatic hemorrhages was lower in SAT patients (3%) than in AMCD patients (18%, p<0.05). Device-related complications in SAT patients comprised two cases of stent fracture and one case of distal migration of a captured thrombus. The proportion of patients with good outcomes, defined as scores from 0 to 3 on the modified Rankin Scale, was similar in the two groups at discharge (SAT, 46%; AMCD, 39%),but significantly higher in the SAT group than in the AMCD group at 3 months (64% vs. 40%,p<0.05) and 6 months (67% vs. 42%, p<0.05) after discharge. Conclusions The outcomes and clinical parameters were better for SAT during thrombolytic procedures for acute intracranial artery occlusions than for AMCD for up to 6 months. However, some device-related complications occurred during stent interventions.
Abstract
Background and Purpose We evaluated whether stent-assisted thrombectomy (SAT) is safer or more clinically beneficial than aggressive mechanical clot disruption (AMCD) for patients with acute intracranial artery occlusion. Methods We retrospectively analyzed the clinical data of 72 patients (33 with SAT and 39with AMCD) who underwent intra-arterial thrombolysis for acute intracranial artery occlusions. Procedure parameters, clinical outcomes, and incidence of complications were compared between the SAT and AMCD groups. Results The time interval to recanalization was shorter in SAT patients (69.2±39.6 minutes,mean±standard deviation) than in AMCD patients (94.4±48.0 minutes, p<0.05). Recanalization was achieved in more SAT patients (91%) than AMCD patients (80%), but with no statistically significance. Urokinase was used less frequently in SAT patients (21%) than in AMCD patients (92%, p<0.05), and the incidence of symptomatic hemorrhages was lower in SAT patients (3%) than in AMCD patients (18%, p<0.05). Device-related complications in SAT patients comprised two cases of stent fracture and one case of distal migration of a captured thrombus. The proportion of patients with good outcomes, defined as scores from 0 to 3 on the modified Rankin Scale, was similar in the two groups at discharge (SAT, 46%; AMCD, 39%),but significantly higher in the SAT group than in the AMCD group at 3 months (64% vs. 40%,p<0.05) and 6 months (67% vs. 42%, p<0.05) after discharge. Conclusions The outcomes and clinical parameters were better for SAT during thrombolytic procedures for acute intracranial artery occlusions than for AMCD for up to 6 months. However, some device-related complications occurred during stent interventions.
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