NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia.
Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Neurosurgery. 2018 Jul 1;83(1):19-28. doi: 10.1093/neuros/nyx386.
The direct aspiration first pass technique (ADAPT) is a recent endovascular treatment for ischemic stroke due to large vessel occlusion that has been gaining popularity due to the rapidity of the technique and the potential for cost savings in comparison to standard thrombectomy methods such as stent retrievers. However, few studies have directly compared these 2.
To compare ADAPT with stent retrievers for thrombectomy via systematic review and meta-analysis.
Ovid Medline, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ACP Journal Club, and Database of Abstracts of Review of Effectiveness limited to English through September 2016 were systematically searched. Eligible studies included those in which patient cohorts underwent ADAPT for acute stroke. Recanalization efficiency, clinical outcomes, and complication rates of ADAPT were compared with the current standard of endovascular thrombectomy techniques.
Seventeen studies on ADAPT and 5 randomized controlled trials on endovascular therapy were included. ADAPT achieved higher rates of complete revascularisation (89.4% vs 71.7%, P < .001) but similar clinical outcomes compared to front-line endovascular therapy. Seventy-one point four percent of ADAPT cases were successfully recanalized with aspiration alone, and a trend towards reduced time from groin puncture to recanalization time was noted (44.77 vs 61.46 min, P = .088).
The pooled results are comparable with recent randomized studies that demonstrate the benefit of endovascular therapy over intra-arterial medical therapy. Future direct comparative studies and randomized trials are required to confirm the benefit of the ADAPT strategy compared to standard endovascular therapy for acute ischemic stroke.
直接抽吸首过技术（ADAPT）是一种最近的血管内治疗方法，用于治疗因大血管闭塞引起的缺血性脑卒中，由于该技术的快速性以及与支架取栓等标准血栓切除术方法相比可能节省成本，因此越来越受欢迎。然而，很少有研究直接比较这两种方法。
通过系统评价和荟萃分析比较 ADAPT 与支架取栓治疗血栓切除术。
系统检索了 Ovid Medline、PubMed、Cochrane 对照试验中心注册库、Cochrane 系统评价数据库、ACP 期刊俱乐部和有效性摘要数据库，仅限 2016 年 9 月前发表的英语文献。纳入的研究包括接受 ADAPT 治疗急性脑卒中的患者队列。比较 ADAPT 的再通效率、临床结局和并发症发生率与目前血管内血栓切除术技术的标准。
纳入了 17 项 ADAPT 研究和 5 项血管内治疗的随机对照试验。ADAPT 实现了更高的完全再通率（89.4%比 71.7%，P <.001），但与一线血管内治疗的临床结局相似。ADAPT 单纯抽吸即可成功再通的比例为 71.4%，且从腹股沟穿刺到再通时间的趋势呈下降趋势（44.77 比 61.46 分钟，P =.088）。
汇集的结果与最近的随机研究结果相当，表明血管内治疗比动脉内药物治疗更有益。需要进一步开展直接比较研究和随机试验，以确认 ADAPT 策略与急性缺血性脑卒中的标准血管内治疗相比的优势。
