Outcome bei Thrombektomie mittels Stentretriever mit Aspiration versus alleinige Aspiration bei Patienten mit ischämischem Schlaganfall, behandelt im UKGM Marburg im Zeitraum von 2012 bis 2019.
Abstract
Stroke is one of the three leading causes of death in Germany as well as worldwide (Roth et al., 2018). The development of stroke therapy progressed from intravenous thrombolysis to aspiration and stent retriever systems. After studies demonstrated good recanalization rates with low complication rates, the thrombolysis time window was adjusted accordingly and extended from 4.5 to 6 hours.
In mechanical thrombectomy, various studies favored the Solitaire retriever over the Merci retriever. Aspiration is considered an alternative to the stent retriever.
Overall, the aim of this doctoral thesis was to evaluate whether the use of a stent retriever or aspiration leads to a significantly better outcome, measured by the modified Rankin Scale (mRS) after 90 days and the NIH Stroke Scale (NIHSS) at discharge.
For this purpose, patient data were collected and analyzed over a period from 2012 to 2019. In addition, baseline parameters of the patients were recorded (age at the time of intervention, sex, NIHSS on admission, ASPECTS, etc.). This also made it possible to investigate whether these parameters influenced the outcome.
After evaluation of the collected data, successful recanalization (TICI ≥ 2b) was observed in 87.4% of patients treated with the stent retriever and in 60.0% of patients treated with the aspiration method (Table 27); this result is statistically significant with p = 0.002. The stent retriever method thus shows clearly superior recanalization results.
The outcome measured by the mRS after 90 days and the NIHSS at discharge with the use of the stent retriever (mean rank for the mRS with stent retriever: 76.66 vs. aspiration: 98.02; mean rank for the NIHSS with stent retriever: 58.39 vs. aspiration: 80.71) is also better; the results are statistically significant with p = 0.041 for the mRS and p = 0.016 for the NIHSS (Table 28).
The mean door-to-groin puncture time (DGPT) was 83 minutes and thus within the target range of < 90 minutes. The door-to-needle time (DNT) was also within the target range, with a median of 30 minutes and a mean value below 60 minutes.
Since recanalization time (≤ 60 min vs. > 60 min) showed no influence on the NIHSS and mRS in the present study, efforts should be made to improve other time parameters.
The time from symptom onset to arrival at the hospital, as well as the rapid transfer of external patients to a larger intervention-ready center, can positively influence long-term outcome.
Alternatively, for patients in whom a relatively long period has elapsed between symptom onset and hospital admission, the time window for mechanical thrombectomy could be expanded. Studies such as DAWN and DEFUSE-3 show that patients with a longer time since infarction (6–24 hours) can also benefit from mechanical thrombectomy.
In this study, bridging therapy with rtPA proved to be statistically significant for improving the NIHSS. Previous studies have already shown that prior intravenous thrombolysis improves outcome. Other studies such as MR CLEAN NO-IV and SWIFT DIRECT, which were initiated in 2021, are investigating to what extent a combination of mechanical thrombectomy and intravenous thrombolysis is superior to mechanical thrombectomy alone.
With regard to NIHSS at admission and ASPECTS, the patient cohort of the present study did not match the baseline parameters reported in the comparative studies in all areas. Compared to the other studies, patients from Marburg differed with regard to long-term outcome and showed poorer results.
One explanation for this is the higher rate of post-interventional complications at UKGM. The rate of pneumonia in particular was high at UKGM.
Despite the higher complication rate, good clinical results were observed: the NIHSS was 17.9 on admission and 9.6 at discharge (Table 14). Overall, only 26.7% of patients died (Table 25).
Based on the data collected in this study, mechanical thrombectomy using a stent retriever and intravenous thrombolytic therapy represents a successful, safe, and minimally invasive treatment for ischemic strokes in the anterior circulation.
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Metadata
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Supervisor:
Dates
Issued: 0006-11-25
Faculty
FB20:Medizin
Language
de
Keywords
mechanische ThrombektomieStentretrieverAspirationischämischer SchlaganfallmRSNIHSS
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Zillmer, Alexandra: Outcome bei Thrombektomie mittels Stentretriever mit Aspiration versus alleinige Aspiration bei Patienten mit ischämischem Schlaganfall, behandelt im UKGM Marburg im Zeitraum von 2012 bis 2019.. : 0006-11-25.
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