From the Department of Diagnostic, Unità Operativa Complessa of Neuroradiology and Interventional Neuroradiology (E.P., S.F., G.D.R., L.B., A.S., A.V., A.P., E.C.)
From the Department of Diagnostic, Unità Operativa Complessa of Neuroradiology and Interventional Neuroradiology (E.P., S.F., G.D.R., L.B., A.S., A.V., A.P., E.C.).
AJNR Am J Neuroradiol. 2021 Mar;42(3):546-550. doi: 10.3174/ajnr.A6987. Epub 2021 Jan 21.
The aspiration technique has gained a prominent role in mechanical thrombectomy. The thrombectomy goal is successful revascularization (modified TICI ≥ 2b) and first-pass effect. The purpose of this study was to evaluate the impact of the vessel-catheter ratio on the modified TICI ≥ 2b and first-pass effect.
This was a retrospective, single-center, cohort study. From January 2018 to April 2020, 111/206 (53.9%) were eligible after applying the exclusion criteria. Culprit vessel diameters were measured by 2 neuroradiologists, and the intraclass correlation coefficient was calculated. The receiver operating characteristic curve was used for assessing the vessel-catheter ratio cutoff for modified TICI ≥ 2b and the first-pass effect. Time to groin puncture and fibrinolysis were weighted using logistic regression. All possible intervals (interval size, 0.1; sliding interval, 0.01) of the vessel-catheter ratio were plotted, and the best and worst intervals were compared using the χ test.
Modified TICI ≥ 2b outcome was achieved in 75/111 (67.5%), and first-pass effect was achieved in 53/75 (70.6%). The MCA diameter was 2.1 mm with an intraclass correlation coefficient of 0.92. The optimal vessel-catheter ratio cutoffs for modified TICI ≥ 2b were ≤1.51 (accuracy = 0.67; 95% CI, 0.58-0.76; = 0.001), and for first-pass effect, they were significant (≤1.33; = .31). The modified TICI ≥ 2b odds ratio and relative risk were 9.2 (95% CI, 2.4-36.2; = 0.002) and 3.2 (95% CI, 1.2-8.7; = .024). The odds ratio remained significant after logistic regression (7.4; 95% CI, 1.7-32.5; = .008). First-pass effect odds ratio and relative risk were not significant (2.1 and 1.5; > .05, respectively). The modified TICI ≥ 2b best and worst vessel-catheter ratio intervals were not significantly different (55.6% versus 85.7%, = .12). The first-pass effect best vessel-catheter ratio interval was significantly higher compared with the worst one (78.6% versus 40.0%, = .03).
The aspiration catheter should be selected according to culprit vessel diameter. The optimal vessel-catheter ratio cutoffs were ≤1.51 for modified TICI ≥ 2b with an odds ratio of 9.2 and a relative risk of 3.2.
抽吸技术在机械血栓切除术中发挥了重要作用。血栓切除的目标是成功再通（改良 TICI ≥ 2b）和首次通过效应。本研究旨在评估血管-导管比对改良 TICI ≥ 2b 和首次通过效应的影响。
这是一项回顾性、单中心队列研究。应用排除标准后，206 例患者中有 111 例（53.9%）符合入选标准。2 名神经放射科医生测量靶血管直径，计算组内相关系数。采用受试者工作特征曲线评估改良 TICI ≥ 2b 和首次通过效应的血管-导管比截断值。采用 logistic 回归分析股动脉穿刺和溶栓时间的权重。绘制血管-导管比所有可能的间隔（间隔大小为 0.1；滑动间隔为 0.01），并通过 χ 检验比较最佳和最差间隔。
111 例患者中 75 例（67.5%）达到改良 TICI ≥ 2b 结局，53 例（70.6%）达到首次通过效应。MCA 直径为 2.1mm，组内相关系数为 0.92。改良 TICI ≥ 2b 的最佳血管-导管比截断值为≤1.51（准确率=0.67；95%CI，0.58-0.76； = 0.001），首次通过效应的截断值为显著（≤1.33； =.31）。改良 TICI ≥ 2b 的比值比和相对风险分别为 9.2（95%CI，2.4-36.2； = 0.002）和 3.2（95%CI，1.2-8.7； =.024）。logistic 回归后比值比仍有统计学意义（7.4；95%CI，1.7-32.5； =.008）。首次通过效应的比值比和相对风险均无统计学意义（2.1 和 1.5； > 0.05）。改良 TICI ≥ 2b 的最佳和最差血管-导管比间隔无统计学差异（55.6%与 85.7%， =.12）。首次通过效应最佳血管-导管比间隔显著高于最差间隔（78.6%与 40.0%， =.03）。
应根据靶血管直径选择抽吸导管。改良 TICI ≥ 2b 的最佳血管-导管比截断值为≤1.51，比值比为 9.2，相对风险为 3.2。
