Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
Department of Medical Imaging, St. Anne's University Hospital Brno, Brno, Czech Republic.
Clin Neuroradiol. 2022 Sep;32(3):799-807. doi: 10.1007/s00062-021-01123-0. Epub 2022 Jan 7.
Successful reperfusion determines the treatment effect of endovascular thrombectomy. We evaluated stent-retriever characteristics and their relation to reperfusion in the ESCAPE-NA1 trial.
Independent re-scoring of reperfusion grade for each attempt was conducted. The following characteristics were evaluated: stent-retriever length and diameter, thrombus position within stent-retriever, bypass effect, deployment in the superior or inferior MCA trunk, use of balloon guide catheter and distal access catheter. Primary outcome was successful reperfusion defined as expanded thrombolysis in cerebral infarction (eTICI) 2b-3 per attempt. The secondary outcome was successful reperfusion eTICI 2b-3 after the first attempt. Separate regression models for each stent-retriever characteristic and an exploratory multivariable modeling to test the impact of all characteristics on successful reperfusion were built.
Of 1105 patients in the trial, 809 with the stent-retriever use (1241 attempts) were included in the primary analysis. The stent-retriever was used as the first-line approach in 751 attempts. A successful attempt was associated with thrombus position within the proximal or middle third of the stent (OR 2.06; 95% CI: 1.24-3.40 and OR 1.92; 95% CI: 1.16-3.15 compared to the distal third respectively) and with bypass effect (OR 1.7; 95% CI: 1.07-2.72). Thrombus position within the proximal or middle third (OR 2.80; 95% CI: 1.47-5.35 and OR 2.05; 95% CI: 1.09-3.84, respectively) was associated with first-pass eTICI 2b-3 reperfusion. In the exploratory analysis accounting for all characteristics, bypass effect was the only independent predictor of eTICI 2b-3 reperfusion (OR 1.95; 95% CI: 1.10-3.46).
The presence of bypass effect and thrombus positioning within the proximal and middle third of the stent-retriever were strongly associated with successful reperfusion.
血管内血栓切除术的治疗效果取决于再灌注是否成功。我们在 ESCAPE-NA1 试验中评估了支架取栓器的特征及其与再灌注的关系。
对每个尝试的再灌注分级进行独立重新评分。评估了以下特征：支架取栓器的长度和直径、血栓在支架取栓器内的位置、旁路效应、在 MCA 干的上或下部分部署、使用球囊引导导管和远端接入导管。主要结局是定义为每个尝试的扩展血栓溶解（eTICI）2b-3 的成功再灌注。次要结局是首次尝试后的 eTICI 2b-3 的成功再灌注。为每个支架取栓器特征建立了单独的回归模型，并进行了探索性多变量建模以测试所有特征对成功再灌注的影响。
在试验中 1105 例患者中，纳入了 809 例使用支架取栓器（1241 次尝试）的患者进行了主要分析。支架取栓器在 751 次尝试中作为一线治疗方法。成功的尝试与血栓在支架的近端或中段（OR 2.06；95%CI：1.24-3.40 和 OR 1.92；95%CI：1.16-3.15 相比，远端三分之一）和旁路效应（OR 1.7；95%CI：1.07-2.72）相关。近端或中段（OR 2.80；95%CI：1.47-5.35 和 OR 2.05；95%CI：1.09-3.84，分别）内的血栓位置与首次通过 eTICI 2b-3 再灌注相关。在考虑所有特征的探索性分析中，旁路效应是 eTICI 2b-3 再灌注的唯一独立预测因子（OR 1.95；95%CI：1.10-3.46）。
旁路效应和支架取栓器内血栓位于近端和中段与再灌注成功密切相关。
