De Marini Pierre, Nayak Sanjeev, Zhu François, Bracard Serge, Anxionnat René, Tonnelet Romain, Liao Liang, Richard Sébastien, Humbertjean Lisa, Mione Gioia, Lacour Jean-Christophe, Derelle Anne-Laure, Gory Benjamin
1 Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France.
2 Royal Stoke University Hospital, Stoke-on-Trent, UK.
Interv Neuroradiol. 2019 Apr;25(2):187-193. doi: 10.1177/1591019918803962. Epub 2018 Oct 5.
A direct aspiration first pass technique involves first-line aspiration to remove the thrombus through a large-bore aspiration catheter in large vessel strokes. The aim of this study was to assess safety and clinical outcomes with a direct aspiration first pass technique using the new ARC catheter.
A retrospective analysis of prospectively collected data from three university hospitals was performed between June 2016 and May 2018. The following parameters of all acute ischemic stroke interventions using the ARC catheter were analyzed: use of intravenous thrombolysis, National Institutes of Health Stroke Scale scores at presentation and discharge, successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b-3), procedure duration, procedure-related complications and 90-day clinical outcome (modified Rankin Scale score).
In total, 41 patients were included in the study and anterior circulation occlusion was noted in 35 (85%). The median National Institutes of Health Stroke Scale at admission was 18 and prior intravenous thrombolysis was administered in 35 patients (85%). Only six (15%) patients required the use of a rescue stent retriever. Successful reperfusion was achieved in 40 patients (98%) with a median procedure time of 32 minutes. No catheter-related complications were observed. Symptomatic intracerebral hemorrhage occurred in one patient (2%). Median National Institutes of Health Stroke Scale at discharge was 3; 49% were independent and 10% died at 90 days.
In the present study, the ARC catheter allowed a 98% successful reperfusion rate. The complication rate was in line with those of previous a direct aspiration first pass technique publications.
直接抽吸首次通过技术是指在大血管卒中时，首先通过大口径抽吸导管进行一线抽吸以清除血栓。本研究的目的是评估使用新型ARC导管的直接抽吸首次通过技术的安全性和临床结局。
对2016年6月至2018年5月期间前瞻性收集的来自三家大学医院的数据进行回顾性分析。分析了所有使用ARC导管进行急性缺血性卒中干预的以下参数：静脉溶栓的使用情况、就诊时和出院时的美国国立卫生研究院卒中量表评分、成功再灌注（改良脑梗死溶栓2b-3级）、手术持续时间、手术相关并发症以及90天临床结局（改良Rankin量表评分）。
本研究共纳入41例患者，其中35例（85%）为前循环闭塞。入院时美国国立卫生研究院卒中量表的中位数为18，35例患者（85%）接受了静脉溶栓治疗。仅6例（15%）患者需要使用补救性支架取栓器。40例患者（98%）实现了成功再灌注，手术时间中位数为32分钟。未观察到与导管相关的并发症。1例患者（2%）发生了症状性脑出血。出院时美国国立卫生研究院卒中量表的中位数为3；49%的患者在90天时独立，10%的患者在90天时死亡。
在本研究中，ARC导管实现了98%的成功再灌注率。并发症发生率与之前直接抽吸首次通过技术的发表结果一致。
