Department of Radiology, Bolzano Central Hospital, Bolzano, Italy,
Radiol Med. 2015 Jul;120(7):655-61. doi: 10.1007/s11547-015-0501-9. Epub 2015 Feb 6.
We report the preliminary results of a single-centre experience in the endovascular treatment (ET) of acute ischemic stroke (AIS) with a sequential endovascular thrombectomy approach (SETA), which comprehends a direct aspiration first-pass technique (ADAPT) eventually followed by stent retriever thrombectomy.
We prospectively analyzed data from 16 patients with severe to moderate AIS and CT angiography demonstration of large intracranial vessel occlusion treated with SETA between July 2013 and March 2014. We evaluated recanalization rate, clinical outcome after 90 days as well as differential costs of aspiration and stent-assisted thrombectomy.
A group of 16 patients met the eligibility criteria to undergo ET with a baseline NIHSS score of 22 (range 12-39). In 15/16 cases, we obtained target vessel recanalization, 11 cases with ADAPT technique alone. Modified rankin score (mRS) at 90 days follow-up was ≤2 in 9/16 patients (56%). ADAPT technique had a lower device-related cost than stent-assisted thrombectomy leading to an overall saving of -2,747.28
Our preliminary data suggest that a SETA beginning with direct aspiration could be useful to optimize ET of stroke in terms of invasiveness, safety and cost-effectiveness allowing recanalization with low complication rate.
我们报告了在单中心进行急性缺血性脑卒中（AIS）血管内治疗（ET）的初步结果，采用了序贯血管内血栓切除术方法（SETA），其中包括直接抽吸首过技术（ADAPT），最终进行支架取栓术。
我们前瞻性分析了 2013 年 7 月至 2014 年 3 月期间 16 例因严重至中度 AIS 且 CT 血管造影显示颅内大血管闭塞而行 SETA 的患者的数据。我们评估了再通率、90 天后的临床结果以及抽吸和支架辅助取栓术的差异成本。
一组 16 例符合 ET 标准的患者基线 NIHSS 评分为 22 分（范围 12-39）。在 16 例中有 15 例成功达到目标血管再通，其中 11 例单独使用 ADAPT 技术。90 天后改良 Rankin 量表（mRS）评分≤2 的患者有 9/16 例（56%）。ADAPT 技术的设备相关成本低于支架辅助取栓术，总体节省-2747.28 欧元。
我们的初步数据表明，起始即采用直接抽吸的 SETA 可能有助于在侵袭性、安全性和成本效益方面优化脑卒中的 ET，实现再通，同时并发症发生率低。
