From the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland.
From the Interventional Neuroradiology Service (D.O., E.G., S.P., P.B., M.S., A.O., S.L., J.T.), Department of Radiology, Beaumont Hospital, Dublin, Ireland
AJNR Am J Neuroradiol. 2019 Aug;40(8):1335-1341. doi: 10.3174/ajnr.A6117. Epub 2019 Jul 18.
Direct aspiration is a recognized technique for revascularization in large-vessel ischemic strokes. There is ongoing debate regarding its efficacy compared with stent retrievers. Every delay in achieving revascularization and a decrease in reperfusion rates reduces the likelihood of patients achieving functional independence. We propose a standardized setup technique for aspiration-first for all anterior circulation thrombectomy procedures for increasing speed and recanalization rates.
We analyzed 127 consecutive patients treated by a standardized approach to thrombectomy with an intention to perform aspiration-first compared with 127 consecutive patients treated with a stent retriever-first approach. Key time metrics evaluated included groin to first angiogram, first angiogram to reperfusion, groin to first reperfusion, and length of the procedure. The degree of successful recanalization (TICI 2b-3) and the number of passes were compared between the 2 groups.
In 127 patients who underwent the standardized technique, the median time from groin puncture to first reperfusion was 18 minutes compared with 26 minutes ( < .001). The duration of the procedure was shorter compared with the stent retriever group (26 minutes in the aspiration first group versus 47 minutes, < .001) and required fewer passes (mean, 2.4 versus 3.1; < .05). A higher proportion of patients had a TICI score of 2b-3 in the aspiration-first group compared with stent retriever group (96.1% versus 85.8%, < .005).
Our study highlights the increasing speed and recanalization rates achieved with fewer passes in a standardized approach to thrombectomy with an intention to attempt aspiration-first. Any attempt to reduce revascularization time and increase successful recanalization should be used.
直接抽吸是治疗大血管缺血性卒中再通的一种公认技术。目前，关于其与支架取栓器相比的疗效仍存在争议。每延迟一次再通和降低一次再灌注率，都会降低患者实现功能独立的可能性。我们提出了一种标准化的抽吸优先的抽吸技术，以提高速度和再通率。
我们分析了 127 例采用标准化方法进行取栓术的连续患者，这些患者的治疗意图是先进行抽吸，而 127 例连续患者采用支架取栓器优先的方法进行治疗。评估的关键时间指标包括腹股沟穿刺至首次血管造影、首次血管造影至再灌注、腹股沟至首次再灌注以及手术时间。比较两组患者的再通程度（TICI 2b-3）和通过次数。
在 127 例接受标准化技术的患者中，从腹股沟穿刺到首次再灌注的中位数时间为 18 分钟，而 26 分钟（<0.001）。与支架取栓组相比，该组的手术时间更短（抽吸优先组 26 分钟，而支架取栓组 47 分钟，<0.001），通过次数更少（平均 2.4 次与 3.1 次，<0.05）。抽吸优先组的 TICI 评分 2b-3 的患者比例高于支架取栓组（96.1%比 85.8%，<0.005）。
我们的研究强调了在标准化取栓术治疗中，采用抽吸优先的方法可以更快地实现再通和更高的再通率，同时通过次数更少。任何旨在缩短再通时间和增加成功再通的尝试都应该被采用。
