Akut inme hastalarında Sofia katater ile direkt aspirasyon yönteminin sonuçları

Yılmaz Önal; Murat Velioğlu; Uğur Demir; Volga Ercan; Ezgi Yakupoğlu; Hakkı M. Karakaş

doi:10.17826/cumj.688708

EN TR

Outcomes of direct aspiration method with Sofia catheter in acute stroke patients

Abstract

Purpose: The aim of this study was to demonstrate the efficacy and safety of direct aspiration method (ADAPT) with 6F Sofia catheter in patients with acute ischemic stroke.
Materials and Methods: Between March 2017 and July 2019, 117 patients who applied for acute stroke and had anterior system large vessel occlusion underwent ADAPT with Sofia catheter were included in our study. Tandem occlusions and posterior system occlusions were not included in the study. Successful recanalization rates, post-operative bleeding complications and 90th day mRS scores of the patients were evaluated.
Results: Occlusion was in the middle cerebral artery (MCA) in 86 (73.5%) of the patients, and internal carotid artery (ICA) bifurcation in 31 (16.5%). Patency rates were evaluated according to Thrombolysis Cerebral Infarction (Tici) score. Successful recanalization (Tici ≥ 2b) was found as 83.7%, and 90th day good clinical outcome (mRS 0-2) was 43.5%. Symptomatic bleeding was observed in 7.69% of the patients. Successful patency was 59.3% in 32 patients who could not be successfully recanalized with ADAPT and additionally used stentretriever. Mortality was observed in 15.3% of the patients.
Conclusion: Sofia can be used effectively and safely in the endovascular treatment of acute stroke with its ability to progress up to the level of occlusion in many patients, with its cost-effectiveness and high successful patency rates with ADAPT.

Keywords

Acute stroke,thrombectomy,Sofia

Akut inme hastalarında Sofia katater ile direkt aspirasyon yönteminin sonuçları

Öz

Amaç: Bu çalışmada akut iskemik inme hastalarında 6F Sofia katater ile direk aspirasyon yönteminin (ADAPT) etkinliği ve güvenirliğinin gösterilmesi amaçlanmıştır.
Gereç ve Yöntem: Çalışmamıza Mart 2017-Temmuz 2019 tarihleri arasında, akut inme nedeniyle başvuran ve ön sistem büyük damar okluzyonu saptanarak Sofia katater ile ADAPT uygulanan 117 hasta dahil edildi. Tandem okluzyonlar ve arka sistem inmeler çalışmaya dahil edilmedi. İşlem sonrası başarılı açıklık oranları, post-operatif kanama komplikasyonları ve hastaların 90. gün modified Rankin Scale (mRS) skorları değerlendirildi.
Bulgular: Hastaların 86’sında (%73.5) okluzyon orta serebral arterde (MCA), 31’inde (%16.5) internal karotis arter (ICA) tepe kısımdaydı. Açıklık oranları Thrombolysis in Cerebral Infarction (Tici) skorlamasına göre değerlendirildi. Başarılı rekanalizasyon (Tici ≥ 2b) %83.7, 90. gün iyi klinik sonuç (mRS 0-2) %43.5 olarak bulundu. Semptomatik kanama ise hastaların %7.69’unda görüldü. ADAPT ile başarılı açıklık sağlanamayan ve ek olarak stentretriever kullanılan 32 hastada başarılı açıklık %59.3 idi. %15.3 hastada mortalite izlendi.
Sonuç: Sofia, hastaların birçoğunda okluzyon seviyesine kadar ilerleyebilmesi, kost-efektif olması ve ADAPT ile yüksek başarılı açıklık oranları sağlaması ile endovasküler inme tedavisinde etkili ve güvenli bir şekilde kullanılabilir

Anahtar Kelimeler

Akut inme,Trombektomi,Sofia

Kaynakça

1. Smith WS, Lev MH, English JD, et al. Significance of large vessel intracranial occlusion causing acute ischemic stroke and TIA. Stroke 2009;40:3834–40.
2. Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11–20.
3. Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015;372:1009–18.
4. Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015;372:1019–30.
5. Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015;372:2296–306.
6. Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015;372:2285–95.
7. Powers WJ, Derdeyn CP, Biller J, et al. American Heart Association/American Stroke Association Focused Update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke 2015;46: 3020–35.
8. Hansen CK, Christensen A, Ovesen C, et al. Stroke severity and incidence of acute large vessel occlusions in patients with hyper-acute cerebral ischemia: results from a prospective cohort study based on CT-angiography (CTA). Int J Stroke 2015;10:336–42.
9. Shallwani H, Shakir HJ, Rangel-Castilla L, Davies JM, Sonig A, Sattur MG, et al. Safety and efficacy of the Sofia (6F) PLUS distal access reperfusion catheter in the endovascular treatment of acute ischemic stroke. Neurosurgery, 2018; 82(3), 312-21.
10. Wessell AP, Cannarsa G, Carvalho H, Kole MJ, Sharma P, Le EJ, et al. Thrombectomy for acute ischemic stroke with the new Sofia 6-French PLUS distal access reperfusion catheter: A single-center experience. The neuroradiology journal, 2019; Epub ahead of print

11. Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. The Lancet, 2014; 384(9958), 1929-35.
12. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, at al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. The Lancet, 2016; 387(10029), 1723-31.
13. Turk AS, Turner R, Spiotta A. Et al. Comparison of endovascular treatment approaches for acute ischemic stroke: cost effectiveness, technical success, and clinical outcomes. J Neurointerv Surg. 2015;7(9):666-70.
14. Hu YC, Stiefel MF. Force and aspiration analysis of the ADAPT technique in acute ischemic stroke treatment. J Neurointerv Surg 2016; 8:244–6.
15. Heit JJ, Wong JH, Mofaff AM, Telischak NA, Dodd RL, Marks MP, et al. Sofia intermediate catheter and the SNAKE technique: safety and efficacy of the Sofia catheter without guidewire or microcatheter construct. Journal of neurointerventional surgery, 2018; 10(4), 401-06.
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Ayrıntılar

Birincil Dil

Türkçe

Konular

Radyoloji ve Organ Görüntüleme

Bölüm

Araştırma Makalesi

Yazarlar

Yılmaz Önal ^*
0000-0001-7703-141X
Türkiye

Murat Velioğlu
0000-0001-9384-2378
Türkiye

Uğur Demir
0000-0002-2500-7538
Türkiye

Volga Ercan
0000-0001-5857-9455
Türkiye

Ezgi Yakupoğlu
0000-0002-8615-6668
Türkiye

Hakkı M. Karakaş
0000-0002-1328-8520
Türkiye

Yayımlanma Tarihi

30 Haziran 2020

Gönderilme Tarihi

13 Şubat 2020

Kabul Tarihi

9 Mart 2020

Yayımlandığı Sayı

Yıl 2020 Cilt: 45 Sayı: 2

DOI

https://doi.org/10.17826/cumj.688708

IZ

https://izlik.org/JA73PP62XL

MLA

Önal, Yılmaz, vd. “Akut inme hastalarında Sofia katater ile direkt aspirasyon yönteminin sonuçları”. Cukurova Medical Journal, c. 45, sy 2, Haziran 2020, ss. 455-60, doi:10.17826/cumj.688708.

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Outcomes of direct aspiration method with Sofia catheter in acute stroke patients

Abstract

Keywords

Akut inme hastalarında Sofia katater ile direkt aspirasyon yönteminin sonuçları

Öz

Anahtar Kelimeler

Kaynakça

Ayrıntılar

Birincil Dil

Konular

Bölüm

Yazarlar

Yayımlanma Tarihi

Gönderilme Tarihi

Kabul Tarihi

Yayımlandığı Sayı

DOI

IZ

Kaynak Göster