Department of Psychiatry, The Second Clinic College of Xinxiang Medical University, Xinxiang, 453000, Henan, China.
Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, No. 388 Jianshe Road, Xinxiang, 453000, Henan, China.
J Neurol. 2021 Dec;268(12):4594-4606. doi: 10.1007/s00415-020-10284-w. Epub 2020 Oct 29.
There is an ongoing debate about whether a direct aspiration first-pass technique (ADAPT) or stent retriever should be used as the first-pass mechanical thrombectomy device for patients with acute ischemic stroke (AIS). This meta-analysis aimed to compare the safety and efficacy of ADAPT versus stent retriever in patients with AIS.
Structured searches on the PubMed, Embase, and Cochrane Library databases were conducted through July 2020. The primary outcomes of this study were: successful and complete recanalization; excellent and favorable outcomes; all-cause mortality at 90 days; and symptomatic intracerebral hemorrhage (sICH). The secondary outcomes of this study were: successful recanalization by primary chosen device; additional therapy; occurrence of emboli in a new territory; hemorrhagic complication; hemorrhagic infarction; parenchymatous hematoma; and subarachnoid hemorrhage. The odds ratios (ORs) with 95% confidence intervals (CIs) of the primary and secondary outcomes were calculated using a random-effects model. I statistics were used to assess the heterogeneity for each outcome among the included studies.
Finally, 20 studies with a total of 6311 patients were included in our meta-analysis. There were no significant differences between the ADAPT group and the stent retriever group of the primary and secondary outcomes except additional therapy. Our pooled results indicated that patients in the ADAPT group needed more additional therapy than those in the stent retriever group (OR 2.24, 95% CI 1.41-3.57).
In conclusion, our meta-analysis showed similar clinical outcomes of ADAPT and stent retriever. However, patients in the ADAPT group had higher additional therapy rates than those in the stent retriever group. Due to several inevitable limitations of this meta-analysis, more large-scale randomized controlled trials are required to further investigate this topic.
对于急性缺血性脑卒中（AIS）患者，是采用直接抽吸首过技术（ADAPT）还是支架取栓器作为首过机械血栓切除术装置，目前仍存在争议。本meta 分析旨在比较 ADAPT 与支架取栓器在 AIS 患者中的安全性和疗效。
通过 2020 年 7 月在 PubMed、Embase 和 Cochrane 图书馆数据库中进行结构化检索。本研究的主要结局为：成功和完全再通；优良和良好结局；90 天全因死亡率；症状性颅内出血（sICH）。本研究的次要结局为：首选设备的初次再通成功率；追加治疗；新出现的栓塞；出血并发症；出血性梗死；实质血肿；蛛网膜下腔出血。使用随机效应模型计算主要和次要结局的优势比（OR）及其 95%置信区间（CI）。采用 I ² 统计量评估各纳入研究间各结局的异质性。
最终，本 meta 分析共纳入 20 项研究，共计 6311 例患者。除追加治疗外，ADAPT 组与支架取栓器组在主要和次要结局方面均无显著差异。汇总结果表明，ADAPT 组患者需要更多的追加治疗（OR 2.24，95%CI 1.41-3.57）。
总之，本 meta 分析显示 ADAPT 和支架取栓器的临床结局相似。然而，ADAPT 组患者的追加治疗率高于支架取栓器组。由于本 meta 分析存在一些不可避免的局限性，需要更多的大规模随机对照试验来进一步研究这一课题。
