Department of Radiology, Rijnstate Hospital, Arnhem, The Netherlands.
Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands.
J Neurointerv Surg. 2019 Jul;11(7):631-636. doi: 10.1136/neurintsurg-2018-014270. Epub 2018 Nov 24.
Mechanical thrombectomy with stent retrievers has proved to be safe and effective in endovascular treatment of acute ischemic stroke. Direct aspiration has shown revascularization rates comparable to those of stent retrievers in the recent ASTER and COMPASS trials. However, the efficacy of aspiration in routine clinical practice has not yet been shown.
To show that aspiration has clinical and technical outcomes equal to those of stent retriever thrombectomy in daily clinical practice.
We analysed data of patients with a large vessel occlusion of the anterior circulation registered in the Dutch MR CLEAN Registry between March 2014 and June 2016. Primary outcome was functional outcome measured with the modified Rankin Scale (mRS) score. Secondary outcomes were reperfusion grade, periprocedural complication rate, and procedure duration. Association of treatment technique with functional outcome was estimated with univariable and multivariable ordinal logistic regression analysis and expressed as a common OR (cOR) for a shift towards better outcome on the mRS.
As first-line treatment, 207 of 1175 patients (17.6%) were treated with direct aspiration, and 968 (82.4%) by a stent retriever. We observed no differences in functional outcome (adjusted cOR=1.020 (95% CI 0.68 to 1.52)) and periprocedural complications. Successful reperfusion (extended Thrombolysis in Cerebral Infarction ≥2b) was similar. Duration of the procedure was shorter with aspiration (57 min (IQR 35-73) vs 70 min (IQR 47-95), p<0.0001).
Direct aspiration shows clinical outcomes equal to those of stent retriever thrombectomy in our large multicenter real-life cohort. We found no difference in complication rates and shorter procedure times for aspiration.
支架取栓术已被证明在急性缺血性脑卒中的血管内治疗中是安全且有效的。在最近的 ASTER 和 COMPASS 试验中，直接抽吸与支架取栓的再通率相当。然而，抽吸在常规临床实践中的疗效尚未得到证实。
证明抽吸在日常临床实践中的临床和技术结果与支架取栓术相当。
我们分析了 2014 年 3 月至 2016 年 6 月期间在荷兰 MR CLEAN 登记处登记的前循环大血管闭塞的患者数据。主要结局是用改良 Rankin 量表（mRS）评分测量的功能结局。次要结局是再灌注等级、围手术期并发症发生率和手术持续时间。用单变量和多变量有序逻辑回归分析估计治疗技术与功能结局的关系，并表示 mRS 评分改善的共同优势比（cOR）。
作为一线治疗，1175 例患者中有 207 例（17.6%）接受直接抽吸治疗，968 例（82.4%）接受支架取栓治疗。我们观察到在功能结局（调整后的 cOR=1.020（95%CI 0.68 至 1.52））和围手术期并发症方面无差异。成功再灌注（扩展脑梗死溶栓≥2b）也相似。抽吸的手术时间更短（57 分钟（IQR 35-73）比 70 分钟（IQR 47-95），p<0.0001）。
在我们的大型多中心真实队列中，直接抽吸的临床结果与支架取栓术相当。我们发现抽吸的并发症发生率和手术时间没有差异。
