Lazzaro Marc A, Zaidat Osama O, Saver Jeffrey L
Department of Neurology, Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wis., USA ; Department of Neurosurgery, Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wis., USA.
Department of Neurology, Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wis., USA ; Department of Neurosurgery, Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wis., USA ; Department of Radiology, Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wis., USA.
Interv Neurol. 2014 Aug;2(4):178-82. doi: 10.1159/000362742.
In the Solitaire With the Intention For Thrombectomy (SWIFT) trial, rescue therapy was used when the Solitaire or Merci device was unable to restore vessel patency. Markers for nonrecanalization in acute stroke have been reported for intravenous tissue plasminogen activator; however, similar predictors are not known for endovascular therapy. We sought to identify predictors and outcomes associated with rescue therapy in the SWIFT trial.
Rescue therapy included the use of an alternative device, agent, or maneuver following failure to recanalize with three retrieval attempts using the initial device. Clinical, angiographic, and demographic data was reviewed.
Among a total of 144 patients enrolled, 43 (29.9%) required rescue therapy. We used the same baseline demographics for patients with and without rescue therapy. Rescue therapy was used in a higher percentage of patients randomized to the Merci group compared with the Solitaire group (43 vs. 21%, p = 0.009). Patients with rescue therapy experienced a longer recanalization time (p < 0.001), a lower percentage of successful recanalization (p < 0.001), and a lower percentage of good outcome (p = 0.009). In multivariate analysis, patients randomized to the Merci group (OR 3.99, 95% CI 1.58, 10.10) and age >80 years (OR 3.51, 95% CI 1.06, 11.64) were predictors of rescue therapy.
Merci treatment group and age were predictors of rescue therapy, while a trend toward an increased need of rescue therapy was observed with hypertension and proximal clot location. Rescue therapy was associated with fewer good outcomes. These findings may reflect targets for improvement in endovascular therapy.
在血栓切除术意向性使用Solitaire（SWIFT）试验中，当Solitaire或Merci装置无法恢复血管通畅时采用了补救治疗。静脉注射组织型纤溶酶原激活剂的急性卒中未再通的标志物已有报道；然而，血管内治疗的类似预测指标尚不清楚。我们试图在SWIFT试验中确定与补救治疗相关的预测指标和结果。
补救治疗包括在使用初始装置进行三次取栓尝试未能再通后，使用替代装置、药物或操作。回顾了临床、血管造影和人口统计学数据。
在总共144例入组患者中，43例（29.9%）需要补救治疗。我们对接受和未接受补救治疗的患者使用相同的基线人口统计学数据。与Solitaire组相比，随机分配到Merci组的患者接受补救治疗的比例更高（43%对21%，p = 0.009）。接受补救治疗的患者再通时间更长（p < 0.001），成功再通的比例更低（p < 0.001），良好预后的比例更低（p = 0.009）。多变量分析中，随机分配到Merci组的患者（OR 3.99，95% CI 1.58，10.10）和年龄>80岁的患者（OR 3.51，95% CI 1.06，11.64）是补救治疗的预测指标。
Merci治疗组和年龄是补救治疗的预测指标，同时观察到高血压和血栓近端位置有补救治疗需求增加的趋势。补救治疗与较少的良好预后相关。这些发现可能反映了血管内治疗的改进目标。
