直接抽吸首次通过技术（ADAPT）用于前循环急性卒中血管内治疗再灌注策略时抽吸成分成功的预测因素
Predictors of the Aspiration Component Success of a Direct Aspiration First Pass Technique (ADAPT) for the Endovascular Treatment of Stroke Reperfusion Strategy in Anterior Circulation Acute Stroke.
作者信息
Blanc Raphaël, Redjem Hocine, Ciccio Gabriele, Smajda Stanislas, Desilles Jean-Philippe, Orng Eliane, Taylor Guillaume, Drumez Elodie, Fahed Robert, Labreuche Julien, Mazighi Mikael, Lapergue Bertrand, Piotin Michel
机构信息
From the Department of Interventional Neuroradiology (R.B., H.R., G.C., S.S., J.-P.D., R.F., M.M., M.P.), Department of Anesthesiology (G.T.), and Department of Pharmacy (E.O.), Rothschild Foundation, France; Department of Biostatistics, University Lille, France (E.D., J.L.); Santé publique: Epidémiologie et Qualité des Soins, Lille, France (E.D., J.L.); INSERM U 1148, Laboratory of Vascular Translational Science, Bichat Hospital, Paris, France (M.M.); Denis Diderot Paris 7 and Sorbonne Paris Cite Universities, France (M.M.); DHU Neurovasc, Paris, France (M.M.); and Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France (B.L.).
Guest Editor for this article was Georgios Tsivgoulis, MD.
出版信息
Stroke. 2017 Jun;48(6):1588-1593. doi: 10.1161/STROKEAHA.116.016149. Epub 2017 Apr 20.
BACKGROUND AND PURPOSE
A direct aspiration first pass technique (ADAPT) has been reported to be fast, safe, and effective for the treatment of acute ischemic stroke. The aim of this study is to determine the preoperative factors that affect success of the aspiration component of the technique in ischemic stroke patients with large vessel occlusion in the anterior circulation.
METHODS
We enrolled all 347 consecutive patients with anterior circulation acute ischemic stroke admitted for mechanical thrombectomy at our institution from August 2013 to October 2015 and treated by ADAPT for the endovascular treatment of stroke. Baseline and procedural characteristics, modified thrombolysis in cerebral infarction scores, and 3-month modified Rankin Scale were captured and analyzed.
RESULTS
Among the 347 patients (occlusion sites: middle cerebral artery=200, 58%; internal carotid artery Siphon=89, 25%; Tandem=58, 17%), aspiration component led to successful reperfusion (modified thrombolysis in cerebral infarction 2b/3 scores) in 55.6% (193/347 patients), stent retrievers were required in 40%, and a total successful final reperfusion rate of 83% (288/347) was achieved. Overall, procedural complications occurred in 13.3% of patients (48/347). Modified Rankin Scale score of 0 to 2 at 90 days was reported in 45% (144/323). Only 2 factors positively influenced the success of the aspiration component: an isolated middle cerebral artery occlusion (<0.001) and a shorter time from stroke onset to clot contact (=0.018).
CONCLUSIONS
In this large retrospective study, ADAPT was shown to be safe and effective for anterior circulation acute ischemic stroke with a final successful reperfusion achieved in 83%. The site of arterial occlusion and delay of the procedure were predictors for reperfusion.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02523261, NCT02678169, and NCT02466893.
背景与目的
据报道，直接抽吸首次通过技术（ADAPT）治疗急性缺血性卒中快速、安全且有效。本研究旨在确定影响该技术抽吸部分在大脑前循环大血管闭塞缺血性卒中患者中成功的术前因素。
方法
我们纳入了2013年8月至2015年10月在我院因机械取栓入院并接受ADAPT进行卒中血管内治疗的347例连续性大脑前循环急性缺血性卒中患者。记录并分析基线和手术特征、改良脑梗死溶栓评分以及3个月改良Rankin量表评分。
结果
在347例患者中（闭塞部位：大脑中动脉=200例，58%；颈内动脉虹吸部=89例，25%；串联病变=58例，17%），抽吸部分导致成功再灌注（改良脑梗死溶栓2b/3级评分）的患者占55.6%（193/347例），40%的患者需要使用支架取栓器，最终成功再灌注率达83%（288/347例）。总体而言，13.3%的患者（48/347例）出现手术并发症。90天时改良Rankin量表评分为0至2分的患者占45%（144/323例）。仅有2个因素对抽吸部分的成功有积极影响：孤立的大脑中动脉闭塞（<0.001）以及从卒中发作到血栓接触的时间较短（=0.018）。
结论
在这项大型回顾性研究中，ADAPT被证明对大脑前循环急性缺血性卒中安全有效，最终成功再灌注率达83%。动脉闭塞部位和手术延迟是再灌注的预测因素。
临床试验注册
网址：http://www.clinicaltrials.gov。唯一标识符：NCT02523261、NCT02678169和NCT02466893。
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