Eesa M, Burns P A, Almekhlafi M A, Menon B K, Wong J H, Mitha A, Morrish W, Demchuk A M, Goyal M
Department of Radiology, University of Calgary, Calgary, Alberta, Canada.
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada Department of Internal Medicine, King Abdulaziz University, Jeddah, Western, Saudi Arabia.
J Neurointerv Surg. 2014 Nov;6(9):649-51. doi: 10.1136/neurintsurg-2013-010906. Epub 2013 Oct 22.
In acute ischemic stroke, good outcome following successful recanalization is time dependent. In patients undergoing endovascular therapy at our institution, recanalization times with the Solitaire stent were retrospectively evaluated to assess for the presence of a learning curve in achieving rapid recanalization.
We reviewed patients who presented to our stroke center and achieved successful recanalization with the Solitaire stent exclusively. Time intervals were calculated (CT to angiography arrival, angiography arrival to groin puncture, groin puncture to first deployment, and deployment to recanalization) from time stamped images and angiography records. Patients were divided into three sequential groups, with overall CT to recanalization time and subdivided time intervals compared.
83 patients were treated with the Solitaire stent from May 2009 to February 2012. Recanalization (Thrombolyis in Cerebral Infarction score 2A) occurred in 75 (90.4%) patients. CT to recanalization demonstrated significant improvement over time, which was greatest between the first 25 and the most recent 25 cases (161-94 min; p<0.01). The maximal contribution to this was from improvements in first stent deployment to recanalization time (p=0.001 between the first and third groups), with modest contributions from moving patients from CT to the angiography suite faster (p=0.02 between the first and third groups) and from groin puncture to first stent deployment (p=0.02 between the first and third groups).
There is a learning curve involved in the efficient use of the Solitaire stent in endovascular acute stroke therapy. Along with improvements in patient transfer to angiography and improved efficiency with intracranial access, mastering this device contributed significantly towards reducing recanalization times.
在急性缺血性卒中中，成功再通后的良好预后具有时间依赖性。在我们机构接受血管内治疗的患者中，对使用Solitaire支架的再通时间进行了回顾性评估，以评估在实现快速再通方面是否存在学习曲线。
我们回顾了那些仅使用Solitaire支架在我们的卒中中心实现成功再通的患者。根据带时间戳的图像和血管造影记录计算时间间隔（从CT到血管造影到达、从血管造影到达至腹股沟穿刺、从腹股沟穿刺至首次支架释放以及从释放至再通）。患者被分为三个连续的组，比较总的从CT到再通的时间以及细分的时间间隔。
2009年5月至2012年2月期间，83例患者接受了Solitaire支架治疗。75例（90.4%）患者实现了再通（脑梗死溶栓评分2A）。从CT到再通的时间随时间有显著改善，在前25例和最近25例之间改善最为明显（161 - 94分钟；p<0.01）。对此最大的贡献来自首次支架释放至再通时间的改善（第一组和第三组之间p = 0.001），将患者更快地从CT转运至血管造影室（第一组和第三组之间p = 0.02）以及从腹股沟穿刺至首次支架释放（第一组和第三组之间p = 0.02）也有一定贡献。
在血管内急性卒中治疗中有效使用Solitaire支架存在学习曲线。随着患者转运至血管造影的改善以及颅内操作效率的提高，掌握该装置对减少再通时间有显著贡献。
