Brehm Alex, Maus Volker, Tsogkas Ioannis, Colla Ruben, Hesse Amélie Carolina, Gera Roland Gerard, Psychogios Marios-Nikos
Department of Neuroradiology, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
Department of Medical Statistics, University Medical Center Goettingen, Humboldtallee 32, 37073, Göttingen, Germany.
BMC Neurol. 2019 Apr 15;19(1):65. doi: 10.1186/s12883-019-1291-9.
Embolectomy is the standard of care in acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). Aim of this study was to compare two techniques: A Direct Aspiration First Pass Technique (ADAPT) and Stent-retriever Assisted Vacuum-locked Extraction (SAVE) stratified by the occluded vessel.
One hundred seventy-one patients (71 male) treated between January 2014 and September 2017 with AIS due to LVO of the anterior circulation (55 carotid T, 94 M1, 22 M2) were included. Treatment techniques were divided into two categories: ADAPT and SAVE. Primary endpoints were successful reperfusion (mTICI ≥2b), near-perfect reperfusion (mTICI ≥2c) and groin puncture to reperfusion time. Secondary endpoints were the number of device-passes, first-pass reperfusion, the frequency of emboli to new territory (ENT), clinical outcome at 90 days, and the frequency of symptomatic intracranial hemorrhage (sICH). Analysis was performed on an intention to treat basis.
Overall, SAVE resulted in significant higher rates of successful reperfusion (mTICI≥2b) compared to ADAPT (93.5% vs 75.0%; p = 0.006). After stratification for the occluded vessel only the carotid T remained significant with higher rates of near-perfect reperfusion (mTICI≥2c) (55.2% vs 15.4%; p = 0.025), while for successful reperfusion a trend remained (93.1% vs 65.4%; p = 0.10). Groin to reperfusion times were not significantly different. Secondary analysis revealed higher rates of first-pass successful reperfusion (59.6% vs 33.3%; p = 0.019), higher rates of first-pass near-perfect reperfusion in the carotid T (35.4% vs 16.7%; p = 0.038) and a lower number of device-passes overall (median 1 IQR 1-2 vs 2 IQR 2-3; p < 0.001) and in the carotid T (median 2 IQR 1.3 vs 3 IQR 2-5; p < 0.001) for SAVE. Clinical outcome and safety parameters were comparable between groups.
Embolectomy using SAVE appears superior to ADAPT, especially for carotid T occlusions with regard to reperfusion success.
对于由大血管闭塞（LVO）引起的急性缺血性卒中（AIS），血管取栓术是标准的治疗方法。本研究的目的是比较两种技术：直接抽吸首次通过技术（ADAPT）和支架取栓器辅助真空锁定抽吸取栓术（SAVE），并按闭塞血管进行分层。
纳入2014年1月至2017年9月间因前循环LVO接受治疗的171例急性缺血性卒中患者（71例男性）（55例颈动脉T段、94例M1段、22例M2段）。治疗技术分为两类：ADAPT和SAVE。主要终点为成功再灌注（改良脑梗死溶栓分级[mTICI]≥2b）、近乎完美再灌注（mTICI≥2c）以及腹股沟穿刺至再灌注时间。次要终点为器械通过次数、首次通过再灌注、栓子进入新区域（ENT）的频率、90天时的临床结局以及症状性颅内出血（sICH）的频率。分析基于意向性治疗原则进行。
总体而言，与ADAPT相比，SAVE导致成功再灌注（mTICI≥2b）的比例显著更高（93.5%对75.0%；p = 0.006）。在按闭塞血管分层后，仅颈动脉T段在近乎完美再灌注（mTICI≥2c）方面仍具有显著差异，比例更高（55.2%对15.4%；p = 0.025），而在成功再灌注方面仍存在趋势差异（93.1%对65.4%；p = 0.10）。腹股沟至再灌注时间无显著差异。二次分析显示，SAVE的首次通过成功再灌注比例更高（59.6%对33.3%；p = 0.019），颈动脉T段的首次通过近乎完美再灌注比例更高（35.4%对16.7%；p = 0.038），且总体器械通过次数更少（中位数1，四分位数间距1 - 2对2，四分位数间距2 - 3；p < 0.001），在颈动脉T段也是如此（中位数2，四分位数间距1.3对3，四分位数间距2 - 5；p < 0.001）。两组间的临床结局和安全性参数具有可比性。
使用SAVE进行血管取栓术似乎优于ADAPT，尤其是在再灌注成功率方面对于颈动脉T段闭塞而言。
