Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
Department of Neurosurgery, Asahikawa Red Cross Hospital, Hokkaido, Japan.
J Stroke Cerebrovasc Dis. 2021 Nov;30(11):106069. doi: 10.1016/j.jstrokecerebrovasdis.2021.106069. Epub 2021 Aug 27.
This study aimed to assess the clinical usefulness of a direct aspiration first pass technique as a first-line strategy for mechanical thrombectomy in posterior circulation.
We examined 34 consecutive patients treated with mechanical thrombectomy for acute vertebrobasilar artery occlusion. Procedural and clinical outcomes were assessed and compared between patients treated with a direct aspiration first pass technique first-line strategy (ADAPT group) and stent retriever system first-line strategy (stent retriever group).
Overall, successful reperfusion, complete reperfusion, and first-pass effects were achieved in 94.1%, 61.8%, and 50% of patients with acute ischemic stroke in vertebra-basilar artery occlusion treated with mechanical thrombectomy, respectively. The ADAPT group required a significantly shorter procedural time (p=.015) and fewer attempts (p=.0498) to achieve successful recanalization than the stent retriever group. The ADAPT group also tended to show better recanalization rates and first-pass effects than the stent retriever group. The rates of favorable outcomes seemed to be better, although insignificant, in the ADAPT group than in the stent retriever group (52.2% vs. 27.3%, p=.217). However, a significant correlation between the time required for reperfusion and clinical outcome was detected, and this will serve as the rationale for encouraging a direct aspiration first pass technique as a first-line strategy in the acute vertebra-basilar artery.
The a direct aspiration first pass technique first-line strategy for mechanical thrombectomy in posterior circulation may achieve successful recanalization with fewer attempts and shorter durations than the stent retriever first-line strategy.
本研究旨在评估直接抽吸首过技术作为治疗后循环机械取栓术的一线策略的临床实用性。
我们研究了 34 例接受机械取栓治疗急性椎基底动脉闭塞的连续患者。评估并比较了采用直接抽吸首过技术一线策略（ADAPT 组）和支架取栓系统一线策略（支架取栓组）的患者的治疗效果和临床结果。
总体而言，接受机械取栓治疗的急性椎基底动脉闭塞性缺血性卒中患者的再通成功率、完全再通率和首过效应分别为 94.1%、61.8%和 50%。ADAPT 组在达到成功再通所需的操作时间（p=.015）和尝试次数（p=.0498）均显著短于支架取栓组。ADAPT 组的再通率和首过效应也倾向于优于支架取栓组。虽然无统计学意义，但 ADAPT 组的良好结局率似乎优于支架取栓组（52.2%对 27.3%，p=.217）。然而，我们检测到再灌注时间与临床结果之间存在显著相关性，这将为鼓励将直接抽吸首过技术作为急性椎基底动脉的一线策略提供依据。
后循环机械取栓术的直接抽吸首过技术一线策略可能比支架取栓系统一线策略具有更高的再通成功率，更少的尝试次数和更短的操作时间。
