直接抽吸首次通过技术（ADAPT）与取栓支架用于急性卒中治疗的观察性比较研究。
A Direct Aspiration, First Pass Technique (ADAPT) versus Stent Retrievers for Acute Stroke Therapy: An Observational Comparative Study.
作者信息
Lapergue B, Blanc R, Guedin P, Decroix J-P, Labreuche J, Preda C, Bartolini B, Coskun O, Redjem H, Mazighi M, Bourdain F, Rodesch G, Piotin M
机构信息
From the Division of Neurology (B.L., J.-P.D., F.B.), Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France
Department of Diagnostic and Interventional Neuroradiology (R.B., B.B., H.R., M.P.), Rothschild Foundation, Paris, France.
出版信息
AJNR Am J Neuroradiol. 2016 Oct;37(10):1860-1865. doi: 10.3174/ajnr.A4840. Epub 2016 Jun 2.
BACKGROUND AND PURPOSE
Mechanical thrombectomy with stent retrievers is now the standard therapy for selected patients with ischemic stroke. The technique of A Direct Aspiration, First Pass Technique for the Endovascular Treatment of Stroke (ADAPT) appears promising with a high rate of recanalization. We compared ADAPT versus stent retrievers (the Solitaire device) for efficacy and safety as a front-line endovascular procedure.
MATERIALS AND METHODS
We analyzed 243 consecutive patients with large intracranial artery occlusions of the anterior circulation, treated within 6 hours with mechanical thrombectomy by either ADAPT or the Solitaire stent. Th primary outcome was complete recanalization (modified TICI ≥ 2b); secondary outcomes included complication rates and procedural and clinical outcomes.
RESULTS
From November 2012 to June 2014, 119 patients were treated with stent retriever (Solitaire FR) and 124 by using the ADAPT with Penumbra reperfusion catheters. The median baseline NIHSS score was the same for both groups (Solitaire, 17 [interquartile range, 11-21] versus ADAPT, 17 [interquartile range, 12-21]). Time from groin puncture to recanalization (Solitaire, 50 minutes [range, 25-80 minutes] versus ADAPT, 45 minutes [range, 27-70 minutes], = .42) did not differ significantly. However, compared with the Solitaire group, patients treated with ADAPT achieved higher final recanalization rates (82.3% versus 68.9%; adjusted relative risk, 1.18; 95% CI, 1.02-1.37; = .022), though differences in clinical outcomes between the cohorts were not significant. Use of an adjunctive device was more frequent in the ADAPT group (45.2% versus 13.5%, < .0001). The rate of embolization in new territories or symptomatic hemorrhage did not differ significantly between the 2 groups.
CONCLUSIONS
Front-line ADAPT achieved higher recanalization rates than the Solitaire device. Further randomized controlled trials are warranted to define the best strategy for mechanical thrombectomy.
背景与目的
使用支架取栓器进行机械取栓术现已成为部分缺血性脑卒中患者的标准治疗方法。直接抽吸首次通过技术（ADAPT）治疗脑卒中的血管内治疗技术显示出较高的再通率，前景良好。我们比较了ADAPT与支架取栓器（Solitaire装置）作为一线血管内治疗方法的疗效和安全性。
材料与方法
我们分析了243例连续的大脑前循环颅内大动脉闭塞患者，这些患者在6小时内接受了ADAPT或Solitaire支架机械取栓治疗。主要结局是完全再通（改良脑梗死溶栓分级[TICI]≥2b）；次要结局包括并发症发生率、手术及临床结局。
结果
2012年11月至2014年6月，119例患者接受了支架取栓器（Solitaire FR）治疗，124例患者使用Penumbra再灌注导管通过ADAPT进行治疗。两组的基线美国国立卫生研究院卒中量表（NIHSS）评分中位数相同（Solitaire组为17[四分位间距，11 - 21]，ADAPT组为17[四分位间距，12 - 21]）。从腹股沟穿刺到再通的时间（Solitaire组为50分钟[范围，25 - 80分钟]，ADAPT组为45分钟[范围，27 - 70分钟]，P = 0.42）差异无统计学意义。然而，与Solitaire组相比，接受ADAPT治疗的患者最终再通率更高（82.3%对68.9%；校正相对风险，1.18；95%置信区间，1.02 - 1.37；P = 0.022），尽管两组间临床结局差异无统计学意义。ADAPT组使用辅助装置的频率更高（45.2%对13.5%，P < 0.0001）。两组新区域栓塞或症状性出血的发生率差异无统计学意义。
结论
一线ADAPT治疗的再通率高于Solitaire装置。有必要进行进一步的随机对照试验来确定机械取栓的最佳策略。
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