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Hirota S, Fujita K, Ishiwada T, Takahashi S, Hirai S, Sagawa H, Wakabayashi H, Aoyama J, Fujii S, Yamaoka H, Yoshimura M, Shigeta K, Sato Y, Sawada K, Yamada K, Yamamura T, Ishii Y, Obata Y, Hara M, Kawano Y, Yamamoto S, Nemoto S, Sumita K. Contact aspiration for basilar artery occlusion safely reduces the puncture-to-recanalization time. Clin Neurol Neurosurg 2024; 242:108331. [PMID: 38795688 DOI: 10.1016/j.clineuro.2024.108331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/25/2024] [Accepted: 05/11/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE Effective thrombectomies in the posterior circulation remain controversial. Previous reports have demonstrated the superiority of contact aspiration in anterior circulation. Aspiration catheters and stent retrievers are often used alone on a global scale, while combined techniques are commonly used in Japan. This study evaluated the effect of first-line contact aspiration with other strategies for the treatment of basilar artery occlusion. METHODS The primary outcome was the frequency of the first-pass effect, and the secondary outcome was the time from puncture to the first-pass effect. A multicenter observational registry including 16 Japanese stroke centers was used. Between December 2013 and February 2021, enrolled patients underwent endovascular thrombectomy for basilar artery occlusion. The efficacy of contact aspiration compared to other methods (including stent retrievers and combined techniques) was evaluated. RESULTS Eighty-four patients were included, all of whom had achieved effective recanalization. Twenty-six patients were treated with contact aspiration, 13 with combined technique, and 45 with stent retrievers. The two groups: contact aspiration and non-contact aspiration, had different backgrounds. Both had similar frequencies of effective recanalization and first-pass effects. The contact aspiration group experienced better functional outcomes without statistical significance, while this strategy was significantly associated with a shorter puncture-to-recanalization time (38 vs. 55 minutes, P=0.036). In particular, in the 55 patients with the first-pass effect, multivariate Cox proportional hazard analysis showed that contact aspiration was significantly associated with a shorter time from puncture to first-pass effect, independent of age and etiology of large-artery atherosclerosis (hazard ratio 2.02, 95% confidence intervals 1.10-3.69, P=0.023). CONCLUSION This study suggested that contact aspiration for basilar artery occlusion may shorten the puncture-to-first-pass effect, compared to stent retrievers and combined techniques.
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Affiliation(s)
- Shin Hirota
- Department of Neurosurgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura-shi, Ibaraki 300-0028, Japan.
| | - Kyohei Fujita
- Department of Endovascular Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Tadahiro Ishiwada
- Department of Neurosurgery, Shioda Memorial Hospital, 550-1 Kori, Choseigun Nagaramachi, Chiba 297-0203, Japan
| | - Satoru Takahashi
- Department of Endovascular Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Sakyo Hirai
- Department of Endovascular Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Hirotaka Sagawa
- Department of Endovascular Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Hikaru Wakabayashi
- Department of Endovascular Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Jiro Aoyama
- Department of Endovascular Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Shoko Fujii
- Department of Endovascular Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Hiroto Yamaoka
- Department of Endovascular Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Masataka Yoshimura
- Department of Neurosurgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura-shi, Ibaraki 300-0028, Japan.
| | - Keigo Shigeta
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, 3256 Midorimachi, Tachikawa-shi, Tokyo 190-0014, Japan
| | - Yohei Sato
- Department of Neurosurgery, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashino-shi, Tokyo 180-8610, Japan.
| | - Kana Sawada
- Department of Neurosurgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu-shi, Chiba 279-0001, Japan.
| | - Kenji Yamada
- Department of Neurosurgery, Shuuwa General Hospital, 1200 Yaharashinden, Kasukabe-shi, Saitama 344-0035, Japan.
| | - Toshihiro Yamamura
- Department of Neurosurgery, Soka Municipal Hospital, 2-21-1 Souka, Souka-shi, Saitama 340-8560, Japan
| | - Yosuke Ishii
- Department of Neurosurgery, Kanto Rosai Hospital, 1-1 Kizukisumiyoshicho, Nakahara-ku, Kawasaki, Kanagawa 211-0021, Japan
| | - Yoshiki Obata
- Department of Neurosurgery, Tokyo-Kita Medical Center, 4-17-56 Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | - Mutsuya Hara
- Department of Neurosurgery, Tokyo Metropolitan Toshima Hospital, 33-1 Sakaemachi, Itabashi-ku, Tokyo 173-0015, Japan.
| | - Yoshihisa Kawano
- Department of Neurosurgery, JA Toride Medical Center, 2-1-1 Hongo, Toride-shi, Ibaraki 302-0022, Japan
| | - Shinji Yamamoto
- Department of Neurosurgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura-shi, Ibaraki 300-0028, Japan.
| | - Shigeru Nemoto
- Department of Neurosurgery, Kanto Rosai Hospital, 1-1 Kizukisumiyoshicho, Nakahara-ku, Kawasaki, Kanagawa 211-0021, Japan.
| | - Kazutaka Sumita
- Department of Endovascular Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
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Fujita K, Sato Y, Hanazawa R, Sagawa H, Ishikawa M, Fujii S, Aoyama J, Hirai S, Yoshimura M, Yoshino Y, Kawano Y, Shigeta K, Taira N, Karakama J, Ishiwada T, Yamashina M, Hirakawa A, Sumita K. Impact of cancer history on long-term outcome after elective neuro-endovascular treatment in patients aged 80 years or older: A retrospective multicenter observational study. Geriatr Gerontol Int 2024; 24:211-217. [PMID: 38126478 DOI: 10.1111/ggi.14784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/27/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
AIM Assessing the indication for elective neuro-endovascular treatment (EVT) in older patients requires consideration of the impact of systemic comorbidities on their overall reduced life expectancy. The objective of this study was to determine the long-term outcomes of elective neuro-EVT in patients aged ≥80 years, and to investigate the impact of pre-existing cancer on their long-term outcomes. METHODS Of the patients enrolled in multicenter observational registry, those aged ≥80 years undergoing elective neuro-EVT between 2011 and 2020 were enrolled. A history of cancer was defined as a pre-existing solid or hematologic malignancy at the time of EVT. The primary outcome was time to death from elective neuro-EVT. RESULTS Of the 6183 neuro-EVT cases implemented at 10 stroke centers, a total of 289 patients (median age, 82 years [interquartile range 81-84 years]) were analyzed. A total of 58 (20.1%) patients had a history of cancer. A total of 78 patients (27.0%) died during follow up. The 5-year survival rate of enrolled patients was 64.6%. Compared with patients without a history of cancer, those with a history of cancer showed significantly worse survival (log-rank test, P = 0.001). Multivariate Cox proportional hazards analysis showed history of cancer was an independent predictor of time to death from elective neuro-EVT (HR 1.74, 95% CI 1.01-3.00, P = 0.047). Cancer was the leading cause of death, accounting for 25.6% of all deaths. CONCLUSIONS The present study showed that history of cancer has a significant impact on time to death from elective neuro-EVT in patients aged ≥80 years. Geriatr Gerontol Int 2024; 24: 211-217.
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Affiliation(s)
- Kyohei Fujita
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yohei Sato
- Department of Neurosurgery, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Ryoichi Hanazawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hirotaka Sagawa
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mariko Ishikawa
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shoko Fujii
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Neurosurgery, Ome Municipal General Hospital, Tokyo, Japan
| | - Jiro Aoyama
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sakyo Hirai
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masataka Yoshimura
- Department of Neurosurgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoshikazu Yoshino
- Department of Neurosurgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yoshihisa Kawano
- Department of Neurosurgery, JA Toride Medical Center, Ibaraki, Japan
| | - Keigo Shigeta
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Naoki Taira
- Department of Neurosurgery, Shuuwa General Hospital, Saitama, Japan
| | - Jun Karakama
- Department of Neurosurgery, Ome Municipal General Hospital, Tokyo, Japan
| | | | | | - Akihiko Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazutaka Sumita
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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