Efficacy and Safety of SWIM Technique for Acute Ischemic Stroke Due to Large Vessel Occlusion in Posterior Circulation

doi:10.3969/j.issn.1673-5765.2020.02.005

Abstract

Abstract:

Objective To observe the efficacy and safety of SWIM technique in the treatment of acute ischemic stroke due to posterior circulation large vessel occlusion. Methods A retrospective analysis of clinical data of patients with posterior circulation acute ischemic stroke treated with SWIM technique in the Dalian Central Hospital from February 2017 to November 2018 was undertaken. The outcomes were reperfusion immediately after surgery (successful reperfusion was defined as mTICI ≥2b), mRS score at 90 days (good prognosis was defined as mRS score ≤2), and any intracranial hemorrhage within 24 hours after surgery and allcause death at 90 days. Results A total of 35 patients were included, with an average age of 66.1±12.1 years, and 26 males (74.3%), the median baseline NIHSS score was 22 (15-34). The rate of successful recanalization was 94.3% (33/35), the rate of good prognosis at 90 days was 45.7% (16/35), the rate of intracranial hemorrhage within 24 hours was 17.1% (6/35), and the all-cause mortality at 90 days was 37.1% (13/35). Univariate analysis showed that the lower NIHSS score at admission (P =0.001), a higher pc-ASPECTS score at admission (P =0.016), a shorter time from onset to door (P =0.039), a shorter time from onset to recanalization (P =0.047), a better reperfusion (P =0.036), and a lower percentage of drinking (P =0.042) were associated with good prognosis. Conclusions SWIM technique is relatively safe and effective for patients with posterior circulation acute ischemic stroke.

Key words: Acute ischemic stroke; Posterior circulation; Large artery occlusion; Mechanical thrombectomy; Prognosis

摘要：

目的观察SWIM技术治疗后循环大血管闭塞所致急性缺血性卒中的有效性及安全性。方法回顾性分析2017年2月-2018年11月于大连市中心医院采用SWIM技术治疗的后循环大血管闭塞所致急性缺血性卒中患者的临床资料，评价该技术的疗效和安全性，并分析影响患者预后的因素。观察指标为术后即刻成功再通（mTICI≥2b）、90 d良好预后（mRS评分≤2分），以及术后24 h任何颅内出血、90 d全因死亡。结果共纳入35例患者，平均年龄66.1±12.1岁，男性26例（74.3%），基线NIHSS评分22（15～34）分。术后即刻成功再通率为94.3%（33/35），90 d良好预后率为45.7%（16/35），24 h颅内出血率为17.1% （6/35），90 d全因死亡率为37.1%（13/35）。单因素分析显示，基线NIHSS评分较低（P =0.001）、基线后循环ASPECTS评分较高（P =0.016）、发病至到院时间较短（P =0.039）、发病至再通时间较短（P =0.047）、血管成功再通率较高（P =0.036）以及饮酒比例较低（P =0.042）与良好预后相关。结论使用SWIM技术治疗后循环急性缺血性卒中相对安全、有效。

关键词: 急性缺血性卒中; 后循环; 大血管闭塞; 机械取栓; 预后

WANG Ya-Jun, FAN Tie-Ping, LI Di. Efficacy and Safety of SWIM Technique for Acute Ischemic Stroke Due to Large Vessel Occlusion in Posterior Circulation[J]. Chinese Journal of Stroke, 2020, 15(02): 135-140.

王亚军，范铁平，李迪. SWIM技术治疗后循环大血管闭塞所致急性缺血性卒中的有效性和安全性观察[J]. 中国卒中杂志, 2020, 15(02): 135-140.

References

[1] 中国卒中学会，中国卒中学会神经介入分会，中华预

防医学会卒中预防与控制专业委员会介入学组. 急性

缺血性卒中血管内治疗中国指南2018[J]. 中国卒中

杂志，2018，13（7）：706-729.

[2] MATTLE H P，ARNOLD M，LINDSBERG P J，et

al. Basilar artery occlusion[J]. Lancet Neurol，2011，

10（11）：1002-1014.

[3] LINDSBERG P J，MATTLE P. Therapy of basilar

artery occlusion：a systematic analysis comparing

intra-arterial and intravenous thrombolysis[J]. Stroke，

2006，37（3）：922-928.

[4] SCHONEWILLE W J，WIJMAN C A，MICHEL

P，et al. Treatment and outcomes of acute basilar

artery occlusion in the Basilar Artery International

Cooperation Study（BASICS）：a prospective

registry study[J]. Lancet Neurol，2009，8（8）：724-

730.

[5] JANG-HYUN B，MOON K B，HOE H J，et al.

Number of stent retriever passes associated with

futile recanalization in acute stroke[J]. Stroke，2018，

49（9）：2088-2095.

[6] VERGOUWEN M D，ALGRA A，PFEFFERKORN

T，et al. Time is brain（stem）in basilar artery

occlusion[J]. Stroke，2012，43（11）：3003-3006.

[7] NAGEL S，KELLERT L，MÖHLENBRUCH

M，et al. Improved clinical outcome after acute

basilar artery occlusion since the introduction of

endovascular thrombectomy devices[J]. Cerebrovasc

Dis，2013，36（5-6）：394-400.

[8] MÖHLENBRUCH M，STAMPFL S，BEHRENS L，

et al. Mechanical thrombectomy with stent retrievers

in acute basilar artery occlusion[J]. AJNR Am J

Neuroradiol，2014，35（5）：959-964.

[9] HUO X，GAO F，SUN X，et al. Endovascular

mechanical thrombectomy with the Solitaire device

for the treatment of acute basilar artery occlusion[J].

World Neurosurg，2016，89：301-308.

[10] BAEK J M，YOON W，KIM S K，et al. Acute

basilar artery occlusion：outcome of mechanical

thrombectomy with Solitaire stent within 8 hours of

stroke onset[J]. AJNR Am J Neuroradiol，2014，35

（5）：989-993.

[11] BROUSSALIS E，HITZL W，MCCOY M，et

al. Comparison of endovascular treatment versus

conservative medical treatment in patients with

acute basilar artery occlusion[J]. Vasc Endovascular

Surg，2013，47（6）：429-437.

[12] MOURAND I，MACHI P，NOGUÉ E，et al.

Diffusion-weighted imaging score of the brain

stem：a predictor of outcome in acute basilar artery

occlusion treated with the Solitaire FR device[J].

AJNR Am J Neuroradiol，2014，35（6）：1117-1123.

[13] MOURAND I，MACHI，P，MILHAUD，D，et al.

Mechanical thrombectomy with the Solitaire device

in acute basilar artery occlusion[J]. J Neurointerv

Surg，2014，6（3）：200-204.

[14] UNO J，KAMEDA K，OTSUJI R，et al. Mechanical

thrombectomy for acute basilar artery occlusion in

early therapeutic time window[J]. Cerebrovascular

Diseases，2017，44（3-4）：217-224.

[15] KHATRI P，ABRUZZO T，YEATTS S D，et al.

Good clinical outcome after ischemic stroke with

successful revascularization is time-dependent[J].

Neurology，2009，73（13）：1066-1072.

[16] KIM Y W，HONG J M，PARK D G，et al. Effect of

intracranial atherosclerotic disease on endovascular

treatment for patients with acute vertebrobasilar

occlusion[J]. AJNR Am J Neuroradiol，2016，37

（11）：2072-2078.

[17] GILBERTI N，GAMBA M，PREMI E，et al.

Endovascular mechanical thrombectomy in basilar

artery occlusion：variables affecting recanalization

and outcome[J]. J Neurol，2016，263（4）：707-713.

[18] GIORGIANNI A，BIRASCHI F，PIANO M，et

al. Endovascular treatment of acute basilar artery

occlusion：Registro Endovascolare Lombardo

Occlusione Basilar Artery（RELOBA）study group

experience[J]. J Stroke Cerebrovasc Dis，2018，27

（9）：2367-2374.

[19] LUO G，MO D，TONG X，et al. Factors Associated

with 90-day outcomes of patients with acute

posterior circulation stroke treated by mechanical

thrombectomy[J/OL]. World Neurosurg，2018，109：

e318-e328[2019-07-13]. https：//doi.org/10.1016/[1] 中国卒中学会，中国卒中学会神经介入分会，中华预

防医学会卒中预防与控制专业委员会介入学组. 急性

缺血性卒中血管内治疗中国指南2018[J]. 中国卒中

杂志，2018，13（7）：706-729.

[2] MATTLE H P，ARNOLD M，LINDSBERG P J，et

al. Basilar artery occlusion[J]. Lancet Neurol，2011，

10（11）：1002-1014.

[3] LINDSBERG P J，MATTLE P. Therapy of basilar

artery occlusion：a systematic analysis comparing

intra-arterial and intravenous thrombolysis[J]. Stroke，

2006，37（3）：922-928.

[4] SCHONEWILLE W J，WIJMAN C A，MICHEL

P，et al. Treatment and outcomes of acute basilar

artery occlusion in the Basilar Artery International

Cooperation Study（BASICS）：a prospective

registry study[J]. Lancet Neurol，2009，8（8）：724-

730.

[5] JANG-HYUN B，MOON K B，HOE H J，et al.

Number of stent retriever passes associated with

futile recanalization in acute stroke[J]. Stroke，2018，

49（9）：2088-2095.

[6] VERGOUWEN M D，ALGRA A，PFEFFERKORN

T，et al. Time is brain（stem）in basilar artery

occlusion[J]. Stroke，2012，43（11）：3003-3006.

[7] NAGEL S，KELLERT L，MÖHLENBRUCH

M，et al. Improved clinical outcome after acute

basilar artery occlusion since the introduction of

endovascular thrombectomy devices[J]. Cerebrovasc

Dis，2013，36（5-6）：394-400.

[8] MÖHLENBRUCH M，STAMPFL S，BEHRENS L，

et al. Mechanical thrombectomy with stent retrievers

in acute basilar artery occlusion[J]. AJNR Am J

Neuroradiol，2014，35（5）：959-964.

[9] HUO X，GAO F，SUN X，et al. Endovascular

mechanical thrombectomy with the Solitaire device

for the treatment of acute basilar artery occlusion[J].

World Neurosurg，2016，89：301-308.

[10] BAEK J M，YOON W，KIM S K，et al. Acute

basilar artery occlusion：outcome of mechanical

thrombectomy with Solitaire stent within 8 hours of

stroke onset[J]. AJNR Am J Neuroradiol，2014，35

（5）：989-993.

[11] BROUSSALIS E，HITZL W，MCCOY M，et

al. Comparison of endovascular treatment versus

conservative medical treatment in patients with

acute basilar artery occlusion[J]. Vasc Endovascular

Surg，2013，47（6）：429-437.

[12] MOURAND I，MACHI P，NOGUÉ E，et al.

Diffusion-weighted imaging score of the brain

stem：a predictor of outcome in acute basilar artery

occlusion treated with the Solitaire FR device[J].

AJNR Am J Neuroradiol，2014，35（6）：1117-1123.

[13] MOURAND I，MACHI，P，MILHAUD，D，et al.

Mechanical thrombectomy with the Solitaire device

in acute basilar artery occlusion[J]. J Neurointerv

Surg，2014，6（3）：200-204.

[14] UNO J，KAMEDA K，OTSUJI R，et al. Mechanical

thrombectomy for acute basilar artery occlusion in

early therapeutic time window[J]. Cerebrovascular

Diseases，2017，44（3-4）：217-224.

[15] KHATRI P，ABRUZZO T，YEATTS S D，et al.

Good clinical outcome after ischemic stroke with

successful revascularization is time-dependent[J].

Neurology，2009，73（13）：1066-1072.

[16] KIM Y W，HONG J M，PARK D G，et al. Effect of

intracranial atherosclerotic disease on endovascular

treatment for patients with acute vertebrobasilar

occlusion[J]. AJNR Am J Neuroradiol，2016，37

（11）：2072-2078.

[17] GILBERTI N，GAMBA M，PREMI E，et al.

Endovascular mechanical thrombectomy in basilar

artery occlusion：variables affecting recanalization

and outcome[J]. J Neurol，2016，263（4）：707-713.

[18] GIORGIANNI A，BIRASCHI F，PIANO M，et

al. Endovascular treatment of acute basilar artery

occlusion：Registro Endovascolare Lombardo

Occlusione Basilar Artery（RELOBA）study group

experience[J]. J Stroke Cerebrovasc Dis，2018，27

（9）：2367-2374.

[19] LUO G，MO D，TONG X，et al. Factors Associated

with 90-day outcomes of patients with acute

posterior circulation stroke treated by mechanical

thrombectomy[J/OL]. World Neurosurg，2018，109：

e318-e328[2019-07-13]. https：//doi.org/10.1016/[1] 中国卒中学会，中国卒中学会神经介入分会，中华预

防医学会卒中预防与控制专业委员会介入学组. 急性

缺血性卒中血管内治疗中国指南2018[J]. 中国卒中

杂志，2018，13（7）：706-729.

[2] MATTLE H P，ARNOLD M，LINDSBERG P J，et

al. Basilar artery occlusion[J]. Lancet Neurol，2011，

10（11）：1002-1014.

[3] LINDSBERG P J，MATTLE P. Therapy of basilar

artery occlusion：a systematic analysis comparing

intra-arterial and intravenous thrombolysis[J]. Stroke，

2006，37（3）：922-928.

[4] SCHONEWILLE W J，WIJMAN C A，MICHEL

P，et al. Treatment and outcomes of acute basilar

artery occlusion in the Basilar Artery International

Cooperation Study（BASICS）：a prospective

registry study[J]. Lancet Neurol，2009，8（8）：724-

730.

[5] JANG-HYUN B，MOON K B，HOE H J，et al.

Number of stent retriever passes associated with

futile recanalization in acute stroke[J]. Stroke，2018，

49（9）：2088-2095.

[6] VERGOUWEN M D，ALGRA A，PFEFFERKORN

T，et al. Time is brain（stem）in basilar artery

occlusion[J]. Stroke，2012，43（11）：3003-3006.

[7] NAGEL S，KELLERT L，MÖHLENBRUCH

M，et al. Improved clinical outcome after acute

basilar artery occlusion since the introduction of

endovascular thrombectomy devices[J]. Cerebrovasc

Dis，2013，36（5-6）：394-400.

[8] MÖHLENBRUCH M，STAMPFL S，BEHRENS L，

et al. Mechanical thrombectomy with stent retrievers

in acute basilar artery occlusion[J]. AJNR Am J

Neuroradiol，2014，35（5）：959-964.

[9] HUO X，GAO F，SUN X，et al. Endovascular

mechanical thrombectomy with the Solitaire device

for the treatment of acute basilar artery occlusion[J].

World Neurosurg，2016，89：301-308.

[10] BAEK J M，YOON W，KIM S K，et al. Acute

basilar artery occlusion：outcome of mechanical

thrombectomy with Solitaire stent within 8 hours of

stroke onset[J]. AJNR Am J Neuroradiol，2014，35

（5）：989-993.

[11] BROUSSALIS E，HITZL W，MCCOY M，et

al. Comparison of endovascular treatment versus

conservative medical treatment in patients with

acute basilar artery occlusion[J]. Vasc Endovascular

Surg，2013，47（6）：429-437.

[12] MOURAND I，MACHI P，NOGUÉ E，et al.

Diffusion-weighted imaging score of the brain

stem：a predictor of outcome in acute basilar artery

occlusion treated with the Solitaire FR device[J].

AJNR Am J Neuroradiol，2014，35（6）：1117-1123.

[13] MOURAND I，MACHI，P，MILHAUD，D，et al.

Mechanical thrombectomy with the Solitaire device

in acute basilar artery occlusion[J]. J Neurointerv

Surg，2014，6（3）：200-204.

[14] UNO J，KAMEDA K，OTSUJI R，et al. Mechanical

thrombectomy for acute basilar artery occlusion in

early therapeutic time window[J]. Cerebrovascular

Diseases，2017，44（3-4）：217-224.

[15] KHATRI P，ABRUZZO T，YEATTS S D，et al.

Good clinical outcome after ischemic stroke with

successful revascularization is time-dependent[J].

Neurology，2009，73（13）：1066-1072.

[16] KIM Y W，HONG J M，PARK D G，et al. Effect of

intracranial atherosclerotic disease on endovascular

treatment for patients with acute vertebrobasilar

occlusion[J]. AJNR Am J Neuroradiol，2016，37

（11）：2072-2078.

[17] GILBERTI N，GAMBA M，PREMI E，et al.

Endovascular mechanical thrombectomy in basilar

artery occlusion：variables affecting recanalization

and outcome[J]. J Neurol，2016，263（4）：707-713.

[18] GIORGIANNI A，BIRASCHI F，PIANO M，et

al. Endovascular treatment of acute basilar artery

occlusion：Registro Endovascolare Lombardo

Occlusione Basilar Artery（RELOBA）study group

experience[J]. J Stroke Cerebrovasc Dis，2018，27

（9）：2367-2374.

[19] LUO G，MO D，TONG X，et al. Factors Associated

with 90-day outcomes of patients with acute

posterior circulation stroke treated by mechanical

thrombectomy[J/OL]. World Neurosurg，2018，109：

e318-e328[2019-07-13]. https：//doi.org/10.1016/[1] 中国卒中学会，中国卒中学会神经介入分会，中华预

防医学会卒中预防与控制专业委员会介入学组. 急性

缺血性卒中血管内治疗中国指南2018[J]. 中国卒中

杂志，2018，13（7）：706-729.

[2] MATTLE H P，ARNOLD M，LINDSBERG P J，et

al. Basilar artery occlusion[J]. Lancet Neurol，2011，

10（11）：1002-1014.

[3] LINDSBERG P J，MATTLE P. Therapy of basilar

artery occlusion：a systematic analysis comparing

intra-arterial and intravenous thrombolysis[J]. Stroke，

2006，37（3）：922-928.

[4] SCHONEWILLE W J，WIJMAN C A，MICHEL

P，et al. Treatment and outcomes of acute basilar

artery occlusion in the Basilar Artery International

Cooperation Study（BASICS）：a prospective

registry study[J]. Lancet Neurol，2009，8（8）：724-

730.

[5] JANG-HYUN B，MOON K B，HOE H J，et al.

Number of stent retriever passes associated with

futile recanalization in acute stroke[J]. Stroke，2018，

49（9）：2088-2095.

[6] VERGOUWEN M D，ALGRA A，PFEFFERKORN

T，et al. Time is brain（stem）in basilar artery

occlusion[J]. Stroke，2012，43（11）：3003-3006.

[7] NAGEL S，KELLERT L，MÖHLENBRUCH

M，et al. Improved clinical outcome after acute

basilar artery occlusion since the introduction of

endovascular thrombectomy devices[J]. Cerebrovasc

Dis，2013，36（5-6）：394-400.

[8] MÖHLENBRUCH M，STAMPFL S，BEHRENS L，

et al. Mechanical thrombectomy with stent retrievers

in acute basilar artery occlusion[J]. AJNR Am J

Neuroradiol，2014，35（5）：959-964.

[9] HUO X，GAO F，SUN X，et al. Endovascular

mechanical thrombectomy with the Solitaire device

for the treatment of acute basilar artery occlusion[J].

World Neurosurg，2016，89：301-308.

[10] BAEK J M，YOON W，KIM S K，et al. Acute

basilar artery occlusion：outcome of mechanical

thrombectomy with Solitaire stent within 8 hours of

stroke onset[J]. AJNR Am J Neuroradiol，2014，35

（5）：989-993.

[11] BROUSSALIS E，HITZL W，MCCOY M，et

al. Comparison of endovascular treatment versus

conservative medical treatment in patients with

acute basilar artery occlusion[J]. Vasc Endovascular

Surg，2013，47（6）：429-437.

[12] MOURAND I，MACHI P，NOGUÉ E，et al.

Diffusion-weighted imaging score of the brain

stem：a predictor of outcome in acute basilar artery

occlusion treated with the Solitaire FR device[J].

AJNR Am J Neuroradiol，2014，35（6）：1117-1123.

[13] MOURAND I，MACHI，P，MILHAUD，D，et al.

Mechanical thrombectomy with the Solitaire device

in acute basilar artery occlusion[J]. J Neurointerv

Surg，2014，6（3）：200-204.

[14] UNO J，KAMEDA K，OTSUJI R，et al. Mechanical

thrombectomy for acute basilar artery occlusion in

early therapeutic time window[J]. Cerebrovascular

Diseases，2017，44（3-4）：217-224.

[15] KHATRI P，ABRUZZO T，YEATTS S D，et al.

Good clinical outcome after ischemic stroke with

successful revascularization is time-dependent[J].

Neurology，2009，73（13）：1066-1072.

[16] KIM Y W，HONG J M，PARK D G，et al. Effect of

intracranial atherosclerotic disease on endovascular

treatment for patients with acute vertebrobasilar

occlusion[J]. AJNR Am J Neuroradiol，2016，37

（11）：2072-2078.

[17] GILBERTI N，GAMBA M，PREMI E，et al.

Endovascular mechanical thrombectomy in basilar

artery occlusion：variables affecting recanalization

and outcome[J]. J Neurol，2016，263（4）：707-713.

[18] GIORGIANNI A，BIRASCHI F，PIANO M，et

al. Endovascular treatment of acute basilar artery

occlusion：Registro Endovascolare Lombardo

Occlusione Basilar Artery（RELOBA）study group

experience[J]. J Stroke Cerebrovasc Dis，2018，27

（9）：2367-2374.

[19] LUO G，MO D，TONG X，et al. Factors Associated

with 90-day outcomes of patients with acute

posterior circulation stroke treated by mechanical

thrombectomy[J/OL]. World Neurosurg，2018，109：

e318-e328[2019-07-13]. https：//doi.org/10.1016/j.wneu.2017.09.171.

[20] SON S，KIM Y W，OH M K，et al. Initial factors

affecting the clinical outcome after successful

recanalization via MR-based mechanical

thrombectomy in patients with acute ischemic stroke

due to basilar artery occlusion[J]. J Neurointerv Surg，

2016，8（9）：889-893.

[21] LEE W J，JUNG K H，RYU Y J，et al. Utility of

digital subtraction angiography-based collateral

evaluation in medically treated acute symptomatic

basilar artery stenosis[J]. Eur J Neurol，2017，24（9）：

1148-1155.

[22] YOON W，KIM S K，HEO T W，et al. Predictors

of good outcome after stent-retriever thrombectomy

in acute basilar artery occlusion[J]. Stroke，2015，46

（10）：2972-2975.

[23] LINDLEY R I，WARDLAW J M，SANDERCOCK P

A，et al. Frequency and risk factors for spontaneous

hemorrhagic transformation of cerebral infarction[J].

J Stroke Cerebrovasc Dis，2004，13（6）：235-246.

[24] 中华医学会神经病学分会，中华医学会神经病学分

会脑血管病学组. 中国急性脑梗死后出血转化诊治

共识2019[J]. 中华神经科杂志，2019，52（4）：252-

265.

[25] KATZAN I L，CEBUL R D，HUSAK S H，et al.

The effect of pneumonia on mortality among patients

hospitalized for acute stroke[J]. Neurology，2003，60

（4）：620-625.