直接抽吸首过技术改为 Solumbra 抽吸系统可改善血管内治疗卒中的技术效果。
Switch Strategy from Direct Aspiration First Pass Technique to Solumbra Improves Technical Outcome in Endovascularly Treated Stroke.
机构信息
Department of Diagnostic, UOC of Neuroradiology and Interventional Neuroradiology, San Camillo-Forlanini Hospital, 00152 Rome, Italy.
Emergency Department, UOSD, Stroke Unit, San Camillo-Forlanini Hospital, 00152 Rome, Italy.
出版信息
Int J Environ Res Public Health. 2021 Mar 6;18(5):2670. doi: 10.3390/ijerph18052670.
BACKGROUND
The major endovascular mechanic thrombectomy (MT) techniques are: Stent-Retriever (SR), aspiration first pass technique (ADAPT) and Solumbra (Aspiration + SR), which are interchangeable (defined as switching strategy (SS)). The purpose of this study is to report the added value of switching from ADAPT to Solumbra in unsuccessful revascularization stroke patients.
METHODS
This is a retrospective, single center, pragmatic, cohort study. From December 2017 to November 2019, 935 consecutive patients were admitted to the Stroke Unit and 176/935 (18.8%) were eligible for MT. In 135/176 (76.7%) patients, ADAPT was used as the first-line strategy. SS was defined as the difference between first technique adopted and the final technique. Revascularization was evaluated with modified Thrombolysis In Cerebral Infarction (TICI) with success defined as mTICI ≥ 2b. Procedural time (PT) and time to reperfusion (TTR) were recorded.
RESULTS
Stroke involved: Anterior circulation in 121/135 (89.6%) patients and posterior circulation in 14/135 (10.4%) patients. ADAPT was the most common first-line technique vs. both SR and Solumbra (135/176 (76.7%) vs. 10/176 (5.7%) vs. 31/176 (17.6%), respectively). In 28/135 (20.7%) patients, the mTICI was ≤ 2a requiring switch to Solumbra. The vessel's diameter positively predicted SS result (odd ratio (OR) 1.12, confidence of interval (CI) 95% 1.03-1.22; = 0.006). The mean number of passes before SS was 2.0 ± 1.2. ADAPT to Solumbra improved successful revascularization by 13.3% (107/135 (79.3%) vs. 125/135 (92.6%)). PT was superior for SS comparing with ADAPT (71.1 min (CI 95% 53.2-109.0) vs. 40.0 min (CI 95% 35.0-45.2); = 0.0004), although, TTR was similar (324.1 min (CI 95% 311.4-387.0) vs. 311.4 min (CI 95% 285.5-338.7); = 0.23).
CONCLUSION
Successful revascularization was improved by 13.3% after switching form ADAPT to Solumbra (final mTICI ≥ 2b was 92.6%). Vessel's diameter positively predicted recourse to SS.
背景
主要的血管内机械血栓切除术（MT）技术有：支架取栓术（SR）、抽吸首通技术（ADAPT）和 Solumbra（抽吸+SR），它们是可互换的（定义为切换策略（SS））。本研究的目的是报告在血管再通失败的卒中患者中从 ADAPT 切换到 Solumbra 的附加价值。
方法
这是一项回顾性、单中心、实用、队列研究。2017 年 12 月至 2019 年 11 月，935 例连续患者入住卒中病房，176/935（18.8%）适合 MT。在 135/176（76.7%）例患者中，ADAPT 被用作一线策略。SS 定义为首次采用的技术与最终采用的技术之间的差异。采用改良的脑梗死溶栓（TICI）评估血管再通，定义 mTICI≥2b 为成功。记录手术时间（PT）和再灌注时间（TTR）。
结果
卒中涉及：前循环 121/135（89.6%）例，后循环 14/135（10.4%）例。ADAPT 是最常见的一线技术，其次是 SR 和 Solumbra（135/176（76.7%）、10/176（5.7%）和 31/176（17.6%））。在 28/135（20.7%）例患者中，mTICI≤2a 需要切换到 Solumbra。血管直径可预测 SS 结果（优势比（OR）1.12，95%置信区间（CI）1.03-1.22； = 0.006）。SS 前的平均通过次数为 2.0±1.2。ADAPT 切换至 Solumbra 可使血管再通成功率提高 13.3%（107/135（79.3%）比 125/135（92.6%））。与 ADAPT 相比，PT 对 SS 更具优势（71.1 分钟（95%CI 53.2-109.0）比 40.0 分钟（95%CI 35.0-45.2）； = 0.0004），尽管 TTR 相似（324.1 分钟（95%CI 311.4-387.0）比 311.4 分钟（95%CI 385.5-338.7）； = 0.23）。
结论
从 ADAPT 切换到 Solumbra 后，血管再通成功率提高了 13.3%（最终 mTICI≥2b 为 92.6%）。血管直径可预测是否需要采用 SS。
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