Yang D, Hao Y, Zi W, Wang H, Zheng D, Li H, Tu M, Wan Y, Jin P, Xiao G, Xiong Y, Xu G, Liu X
From the Department of Neurology (D.Y., H.W., X.L.), Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu Province, China.
Department of Neurology (Y.H., G.Xu, X.L.), Jinling Hospital, Southern Medical University, Nanjing, Jiangsu Province, China.
AJNR Am J Neuroradiol. 2017 Aug;38(8):1586-1593. doi: 10.3174/ajnr.A5232. Epub 2017 Jun 8.
In clinical practice, stent diameter is one of the variable properties important for endovascular treatment. A consensus guideline for stent retriever size selection has yet to be established. The aim of this study was to investigate the effects of different diameters of Solitaire retrievers on outcomes.
Of 628 patients enrolled from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry, 256 were treated with the Solitaire 4-mm device and 372, with the 6-mm device. We matched patients treated with the 2 stent sizes using propensity score analysis. The successful outcome was reperfusion as measured by the modified Thrombolysis in Cerebral Infarction score immediately postprocedure and the dichotomized modified Rankin Scale score at 90 days. Symptomatic intracerebral hemorrhage and in-hospital mortality were also recorded.
After propensity score analysis, group outcomes did not differ. In addition, in patients with atherosclerosis-related occlusion, a higher reperfusion rate ( = .021) was observed in the Solitaire 4 group, as well as a shorter time interval ( = .002) and fewer passes ( = .025). Independent predictors of successful reperfusion in patients with atherosclerotic disease on logistic analysis were the small stent (OR, 3.217; 95% CI, 1.129-9.162; = .029) and the propensity score acting as a covariate (OR, 52.84; 95% CI, 3.468-805.018; = .004).
We found no evidence of a differential effect of intra-arterial therapy based on the size of Solitaire retrievers. In patients with atherosclerotic disease, favorable reperfusion was associated with deployment of a small stent.
在临床实践中，支架直径是血管内治疗重要的可变属性之一。关于取栓支架尺寸选择的共识指南尚未确立。本研究旨在探讨不同直径的Solitaire取栓支架对治疗结果的影响。
从急性前循环缺血性卒中血管内治疗注册研究中纳入的628例患者中，256例接受了4毫米的Solitaire装置治疗，372例接受了6毫米的装置治疗。我们使用倾向评分分析对接受两种支架尺寸治疗的患者进行匹配。成功的治疗结果是术后立即通过改良脑梗死溶栓评分测量的再灌注以及90天时改良Rankin量表二分法评分。还记录了症状性脑出血和住院死亡率。
经过倾向评分分析，两组的治疗结果没有差异。此外，在动脉粥样硬化相关闭塞的患者中，Solitaire 4组观察到更高的再灌注率（P = 0.021），以及更短的时间间隔（P = 0.002）和更少的操作次数（P = 0.025）。逻辑分析显示，动脉粥样硬化疾病患者成功再灌注的独立预测因素是小尺寸支架（OR，3.217；95%CI，1.129 - 9.162；P = 0.029）和作为协变量的倾向评分（OR，52.84；95%CI，3.468 - 805.018；P = 0.004）。
我们没有发现基于Solitaire取栓支架尺寸的动脉内治疗存在差异效应的证据。在动脉粥样硬化疾病患者中,良好的再灌注与小尺寸支架的植入有关。
