Fan Hongxing, Li Zhenhui, Li Yi, Tan Yanping, Mao Zhenlin, Liu Qian, Zhu Youfeng
Department of Neurology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China.
Department of Critical Care Medicine, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China.
Front Neurol. 2023 Feb 24;14:1138993. doi: 10.3389/fneur.2023.1138993. eCollection 2023.
The stent retriever thrombectomy (SRT) and a direct aspiration first-pass technique (ADAPT) are the two main mechanical thrombectomy (MT) techniques for acute ischemic stroke. Few data are available for comparing the therapeutic effects associated with the two mechanical thrombectomy techniques in acute ischemic stroke with atrial fibrillation. The purpose of this study was to compare the efficacy and safety of both techniques for the treatment of acute large vessel occlusion stroke in the anterior circulation with atrial fibrillation.
Retrospective analysis was performed in stroke patients with atrial fibrillation admitted to Guangzhou Red Cross Hospital from January 2018 to June 2022 who received mechanical thrombectomy by either SRT or ADAPT. Comparisons were made with regards to the initial traits, course of therapy, effectiveness indicators, and complications of these individuals. The primary outcome is recanalization rate.
In this study, after screening 431 patients, 92 eligible patients, with 48 patients received SRT and 44 patients received ADAPT, were included. There was no significant difference in the recanalization rate between the two groups (SRT 87.5% vs. ADAPT 84.1%, = 0.639). Compared with SRT, patients in ADAPT group had a shorter puncture to recanalization time [33.5 min (27.0-59.5) vs. 50.5 min (31.5-91.5), = 0.009], a higher first pass success recanalization rate (54.5 vs. 33.3%, = 0.040), and a higher rate of patients with improvement of NIHSS scores ≥4 at discharge (84.1 vs. 56.3%, = 0.004). However, distal embolization occurred more frequently in the ADAPT group than that in SRT group (50.0 vs. 22.9%, = 0.007). There was no significant difference between the two groups in the 3-month mRS score, symptomatic cerebral hemorrhage, or mortality.
Compared with SRT, ADAPT has similar recanalization rate for the treatment of acute large vessel occlusion stroke in the anterior circulation with atrial fibrillation. However, ADAPT might be more effective in terms of shorter puncture to recanalization time and higher first pass success recanalization rate. Further studies are needed for confirming our results.
支架取栓术（SRT）和直接首次抽吸技术（ADAPT）是急性缺血性卒中的两种主要机械取栓（MT）技术。关于这两种机械取栓技术在伴有心房颤动的急性缺血性卒中中的治疗效果对比的数据较少。本研究的目的是比较这两种技术治疗伴有心房颤动的前循环急性大血管闭塞性卒中的疗效和安全性。
对2018年1月至2022年6月在广州红十字会医院住院、接受SRT或ADAPT机械取栓的伴有心房颤动的卒中患者进行回顾性分析。比较这些患者的初始特征、治疗过程、有效性指标和并发症。主要结局是再通率。
本研究中，在筛查431例患者后，纳入了92例符合条件的患者，其中48例接受SRT，44例接受ADAPT。两组的再通率无显著差异（SRT为87.5%，ADAPT为84.1%，P = 0.639）。与SRT相比，ADAPT组患者从穿刺到再通的时间更短[33.5分钟（27.0 - 59.5）对50.5分钟（31.5 - 91.5），P = 0.009]，首次通过成功再通率更高（54.5%对33.3%，P = 0.040），出院时美国国立卫生研究院卒中量表（NIHSS）评分改善≥4分的患者比例更高（84.1%对56.3%，P = 0.004）。然而，ADAPT组远端栓塞的发生率高于SRT组（50.0%对22.9%，P = 0.007）。两组在3个月改良Rankin量表（mRS）评分、症状性脑出血或死亡率方面无显著差异。
与SRT相比，ADAPT在治疗伴有心房颤动的前循环急性大血管闭塞性卒中时具有相似的再通率。然而，ADAPT在缩短穿刺到再通时间和提高首次通过成功再通率方面可能更有效。需要进一步研究来证实我们的结果。
