혈관 내 재개통 시술을 한 급성 뇌졸중 환자에서 병인과 시술 방법에 따른 재개통 비율에 대한 분석

다국어 초록 (Multilingual Abstract)

Objective
To investigate the efficacy of the concurrent use of both contact aspiration and stent-retriever in stroke patients with emergent large vessel occlusion according to the stroke mechanism, especially highlighting cancer-associated stroke
Methods
We retrospectively analyzed consecutive ischemic stroke patients who had undergone endo-vascular thrombectomy. Eligible patients were dichotomized according to the ischemic stroke etiology: Cancer-associated stroke vs. non-cancer-associated stroke group. Cancer-associated stroke was defined as cryptogenic stroke with active cancer. The combined technique was defined as the concurrent use of contact aspiration and stent-retriever at least once at any stage of the thrombectomy procedure. Successful recanalization was defined as a modified TICI grade 2b or 3 at the end of the procedure. Univariate and multivariate logistic regression models for having successful recanalization were established and analyzed.
Results
A total of 393 patients (mean age, 68.8 years; 216 males [55.0%]) were enrolled. Among them, 56 patients (14.2%) were assigned to the cancer-associated stroke group. The recanalization rate (69.6% vs. 91.7%, P<0.001) and the proportion of a 3-month good clinical outcome (25.5% vs. 42.0%, P = 0.025) were lower in the cancer-associated stroke group. In the univariate and multivariate analysis of the whole cohort, the combined technique was not associated with successful recanalization (OR = 0.99, 95% CI, 0.471 - 2.099, P = 0.988). However, the interaction term between the combined technique and ischemic stroke mechanism was independently associated with successful recanalization (P = 0.032). In multivariate analysis of the cancer-associated stroke group, the combined technique was independently associated with successful recanalization (OR = 5.795, 95% CI, 1.164 - 28.861, P = 0.032).
Conclusion
The combined technique was associated with successful recanalization in cancer-associated stroke patients with emergent large vessel occlusion.

목차 (Table of Contents)

• Contents
• Abstract i
• Contents iii
• Tables and Figures iv
• Introduction 1
• 1. The rise of endovascular thrombectomy 1
• 2. The advent of aspiration thrombectomy and the combined technique 3
• 3. Applicability of combined technique in the cancer-associated stroke 5
• Methods 7
• 1. Study design and patient selection 7
• 2. Clinical assessment 7
• 3. Imaging assessment 8
• 4. Definition of the outcomes 9
• 5. Routine process of mechanical thrombectomy 10
• 6. Statistical analysis 11
• Results 13
• 1. Patient characteristics 13
• 2. Comparison between groups according to the stroke mechanism 13
• 3. Mechanical thrombectomy devices used during the procedure 14
• 4. Factors associated with 3-month good clinical outcome 15
• 5. Factors associated with successful recanalization 15
• 6. Factors associated with any hemorrhage 16
• Discussion 17
• Conclusion 21
• References 22
• 국문요약 41