ADAPT 技术治疗急性缺血性脑卒中的长期经验。
Long term experience using the ADAPT technique for the treatment of acute ischemic stroke.
机构信息
Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA.
出版信息
J Neurointerv Surg. 2017 May;9(5):437-441. doi: 10.1136/neurintsurg-2015-012211. Epub 2016 Apr 18.
INTRODUCTION
The direct aspiration first pass technique (ADAPT) has been introduced as a simple and fast method for achieving good angiographic and clinical outcomes using large bore aspiration catheters for the treatment of acute ischemic stroke (AIS). We present a single center's long term experience with ADAPT.
METHODS
Retrospective analysis of a database was gathered on patients undergoing stroke thrombectomy with ADAPT at a stroke center. Specific parameters captured included age, gender, National Institutes of Health Stroke Scale (NIHSS) score at presentation, time to presentation from last normal, and modified Rankin Scale (mRS) score at the 90 day follow-up. Radiological and angiographic imaging was reviewed to document the location of the vascular occlusion, Thrombolysis in Cerebral Infarction (TICI) flow postprocedure, and procedural complications.
RESULTS
191 consecutive patients who suffered an AIS treated with ADAPT were reviewed; 91 were women, and mean age was 67 years. Patients presented with a mean NIHSS score of 15.4, and 71 patients received intravenous tissue plasminogen activator. The average time from onset to puncture was 7.8 h. The average time for recanalization was 37.3 min. TICI 2B or better recanalization was achieved in 180 (94.2%) patients. 98 (54.1%) patients had an mRS of 0-2 at 90 days. Direct aspiration alone was performed in 145 cases, and 43 cases required the additional use of a stent retriever. There was no significant difference in presenting NIHSS score, average time to presentation, average mRS at 90 days, or 90 day mortality between the two groups. Time to recanalization was 29.6 min for direct aspiration compared with 61.4 min in cases that required adjunct devices (p=0.00000201). 79 (57.7%) patients who underwent direct aspiration only achieved a good outcome at 90 days (mRS 0-2) compared with 19 (43.2%) who underwent adjunct therapies (p=0.12).
CONCLUSIONS
ADAPT is an effective method to achieve good clinical and angiographic outcomes, and serves as a useful firstline method for revascularization.
简介
直接抽吸首过技术（ADAPT）已被引入为一种简单而快速的方法，使用大口径抽吸导管治疗急性缺血性卒中（AIS），以实现良好的血管造影和临床结果。我们介绍了一家卒中中心使用 ADAPT 的长期经验。
方法
对一家卒中中心接受 ADAPT 治疗的卒中取栓患者的数据库进行回顾性分析。捕获的具体参数包括年龄、性别、就诊时的国立卫生研究院卒中量表（NIHSS）评分、从最后正常时间到就诊的时间，以及 90 天随访时的改良 Rankin 量表（mRS）评分。回顾影像学和血管造影图像，记录血管闭塞的位置、术后血栓溶解（TICI）血流情况以及手术并发症。
结果
回顾性分析了 191 例接受 ADAPT 治疗的 AIS 患者；91 例为女性，平均年龄为 67 岁。患者就诊时 NIHSS 评分为 15.4 分，71 例接受静脉组织型纤溶酶原激活剂治疗。从发病到穿刺的平均时间为 7.8 小时。再通的平均时间为 37.3 分钟。180 例（94.2%）患者 TICI 2B 或更好再通。98 例（54.1%）患者在 90 天时 mRS 为 0-2。145 例仅行直接抽吸，43 例需要附加使用支架取栓器。两组患者的就诊 NIHSS 评分、平均就诊时间、90 天平均 mRS 或 90 天死亡率无显著差异。直接抽吸组再通时间为 29.6 分钟，需要辅助装置的病例为 61.4 分钟（p=0.00000201）。仅行直接抽吸的 79 例（57.7%）患者在 90 天时获得良好结局（mRS 0-2），而行辅助治疗的 19 例（43.2%）患者获得良好结局（p=0.12）。
结论
ADAPT 是一种获得良好临床和血管造影结果的有效方法，是血管再通的有用一线方法。
Zotero 插件