前循环大血管闭塞的一线取栓策略：前瞻性ETIS注册研究结果
First-line thrombectomy strategy for anterior large vessel occlusions: results of the prospective ETIS egistry.
作者信息
Maïer Benjamin, Finitsis Stephanos, Bourcier Romain, Papanagiotou Panagiotis, Richard Sébastien, Marnat Gaultier, Sibon Igor, Dargazanli Cyril, Arquizan Caroline, Blanc Raphael, Piotin Michel, Lapergue Bertrand, Consoli Arturo, Eugene Francois, Vannier Stephane, Saleme Suzana, Macian Francisco, Clarençon Frédéric, Rosso Charlotte, Naggara Olivier, Turc Guillaume, Viguier Alain, Cognard Christophe, Wolff Valerie, Pop Raoul, Mazighi Mikael, Gory Benjamin
机构信息
Department of Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, Île-de-France, France
Université de Paris, Paris, Île-de-France, France.
出版信息
J Neurointerv Surg. 2022 May;14(5). doi: 10.1136/neurintsurg-2021-017505. Epub 2021 May 10.
BACKGROUND
The best recanalization strategy for mechanical thrombectomy (MT) remains unknown as no randomized controlled trial has simultaneously evaluated first-line stent retriever (SR) versus contact aspiration (CA) versus the combined approach (SR+CA).
OBJECTIVE
To compare the efficacy and safety profiles of SR, CA, and SR+CA in patients with acute ischemic stroke (AIS) treated by MT.
METHODS
We analyzed data of the Endovascular Treatment in Ischemic Stroke (ETIS) Registry, a prospective, multicenter, observational study of patients with AIS treated by MT. Patients with M1 and intracranial internal carotid artery (ICA) occlusions between January 2015 and March 2020 in 15 comprehensive stroke centers were included. We assessed the association of first-line strategy with favorable outcomes at 3 months (modified Rankin Scale score 0-2), successful recanalization rates (modified Thrombolysis In Cerebral Infarction (mTICI) 2b/3), and safety outcomes.
RESULTS
We included 2643 patients, 406 treated with SR, 1126 with CA, and 1111 with SR+CA. CA or SR+CA achieved more successful recanalization than SR for M1 occlusions (aOR=2.09, (95% CI 1.39 to 3.13) and aOR=1.69 (95% CI 1.12 to 2.53), respectively). For intracranial ICA, SR+CA achieved more recanalization than SR (aOR=2.52 (95% CI 1.32 to 4.81)), no differences were observed between CA and SR+CA. SR+CA was associated with lower odds of favorable outcomes compared with SR (aOR=0.63 (95% CI 0.44 to 0.90)) and CA (aOR=0.71 (95% CI 0.55 to 0.92)), higher odds of mortality at 3 months (aOR=1.56 (95% CI 1.22 to 2.0)) compared with CA, and higher odds of symptomatic intracranial hemorrhage (aOR=1.59 (95% CI 1.1 to 2.3)) compared with CA.
CONCLUSIONS
Despite high recanalization rates, our results question the safety of the combined approach, which was associated with disability and mortality. Randomized controlled trials are needed to evaluate the efficacy and safety of these techniques.
背景
由于尚无随机对照试验同时评估一线支架取栓器（SR）与接触抽吸（CA）以及联合治疗方法（SR+CA），机械取栓术（MT）的最佳再通策略仍不明确。
目的
比较SR、CA和SR+CA在接受MT治疗的急性缺血性卒中（AIS）患者中的疗效和安全性。
方法
我们分析了缺血性卒中血管内治疗（ETIS）注册研究的数据，这是一项对接受MT治疗的AIS患者进行的前瞻性、多中心观察性研究。纳入了2015年1月至2020年3月期间在15个综合卒中中心发生M1段和颅内颈内动脉（ICA）闭塞的患者。我们评估了一线治疗策略与3个月时良好预后（改良Rankin量表评分0-2）、成功再通率（改良脑梗死溶栓（mTICI）2b/3）和安全性结局之间的关联。
结果
我们纳入了2643例患者，406例接受SR治疗，1126例接受CA治疗，1111例接受SR+CA治疗。对于M1段闭塞，CA或SR+CA的再通成功率高于SR（调整后比值比分别为2.09，（95%可信区间1.39至3.13）和1.69（95%可信区间1.12至2.53））。对于颅内ICA，SR+CA的再通成功率高于SR（调整后比值比为2.52（95%可信区间1.32至4.81）），CA和SR+CA之间未观察到差异。与SR（调整后比值比为0.63（95%可信区间0.44至0.9））和CA（调整后比值比为0.71（95%可信区间0.55至0.92））相比，SR+CA与良好预后的几率较低相关，与CA相比，3个月时死亡几率较高（调整后比值比为1.56（95%可信区间1.22至2.0）），与CA相比，有症状颅内出血的几率较高（调整后比值比为1.59（95%可信区间1.1至2.3））。
结论
尽管再通率较高，但我们的结果对联合治疗方法的安全性提出了质疑，该方法与残疾和死亡率相关。需要进行随机对照试验来评估这些技术的疗效和安全性。
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