急性缺血性脑卒中神经血栓切除术的初次通过效应：急性缺血性脑卒中血管内治疗患者的系统评价分析登记研究。
First Pass Effect With Neurothrombectomy for Acute Ischemic Stroke: Analysis of the Systematic Evaluation of Patients Treated With Stroke Devices for Acute Ischemic Stroke Registry.
机构信息
Department of Neurology and Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.).
HonorHealth Research Institute, Scottsdale, AZ (S.M.D).
出版信息
Stroke. 2022 Feb;53(2):e30-e32. doi: 10.1161/STROKEAHA.121.035457. Epub 2021 Nov 17.
BACKGROUND AND PURPOSE
Achieving complete revascularization after a single pass of a mechanical thrombectomy device (first pass effect [FPE]) is associated with good clinical outcomes in patients with acute ischemic stroke due to large vessel occlusion. We assessed patient characteristics, outcomes, and predictors of FPE among a large real-world cohort of patients (Systematic Evaluation of Patients Treated with Stroke Devices for Acute Ischemic Stroke registry).
METHODS
Demographics, clinical outcomes, and procedural characteristics were analyzed among patients in whom FPE (modified Thrombolysis in Cerebral Infarction 2c/3 after first pass) was achieved versus those requiring multiple passes (MP). Modified FPE and modified MP included patients achieving modified Thrombolysis in Cerebral Infarction 2B-3. Primary outcomes included 90-day modified Rankin Scale (mRS) score and mortality.
RESULTS
Among 984 Systematic Evaluation of Patients Treated with Stroke Devices for Acute Ischemic Stroke patients, 930 had complete 90-day follow-up. FPE was achieved in 40.5% (377/930) of patients and MP in 20.0% (186/930). Baseline characteristics were similar across all groups. The FPE group had fewer internal carotid artery occlusions compared with MP (=0.029). The FPE group had faster puncture to recanalization time (≤0.001), higher rates of 90-day mRS score of 0 to 1 (52.6% versus 38.6%, =0.003), mRS score of 0 to 2 (65.4% versus 52.0%, =0.003), and lower 90-day mortality compared with the MP group (12.0% versus 18.7%, =0.038). Similarly, compared with modified MP patients, the modified FPE group had fewer internal carotid artery occlusions (=0.004), faster puncture to recanalization time (≤0.001), and higher rates of 90-day mRS score of 0 to 1 (=0.002) and mRS score of 0 to 2 (=0.003).
CONCLUSIONS
Our findings demonstrate that FPE and modified FPE are associated with superior clinical outcomes.
背景与目的
在单次使用机械血栓切除术装置（单次通过效果[FPE]）后实现完全再通与大血管闭塞性急性缺血性卒中患者的良好临床结局相关。我们评估了系统评价急性缺血性卒中患者接受卒中装置治疗患者（急性缺血性卒中治疗用系统评价患者设备登记研究）中大型真实队列患者的特征、结局和 FPE 的预测因素。
方法
分析了 FPE（首次通过后改良脑梗死溶栓试验 2c/3）患者与需要多次通过（MP）患者之间的人口统计学、临床结局和治疗过程特征。改良 FPE 和改良 MP 包括达到改良脑梗死溶栓试验 2B-3 的患者。主要结局包括 90 天改良 Rankin 量表（mRS）评分和死亡率。
结果
在 984 例系统评价急性缺血性卒中患者接受卒中装置治疗的患者中，930 例患者有完整的 90 天随访资料。FPE 组 40.5%（377/930）的患者达到 FPE，MP 组 20.0%（186/930）。所有组的基线特征相似。FPE 组颈内动脉闭塞的比例低于 MP 组（=0.029）。FPE 组的穿刺至再通时间更短（≤0.001），90 天 mRS 评分 0-1 的比例更高（52.6%对 38.6%，=0.003），mRS 评分 0-2 的比例更高（65.4%对 52.0%，=0.003），90 天死亡率低于 MP 组（12.0%对 18.7%，=0.038）。同样，与改良 MP 患者相比，改良 FPE 组颈内动脉闭塞的比例更少（=0.004），穿刺至再通时间更短（≤0.001），90 天 mRS 评分 0-1 的比例更高（=0.002），mRS 评分 0-2 的比例更高（=0.003）。
结论
我们的研究结果表明，FPE 和改良 FPE 与更好的临床结局相关。
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