单纯使用支架取栓器实现大血管闭塞首次通过效应的临床影响：单中心回顾性分析
Clinical Impact of Large Vessel Occlusion Achieved First Pass Effect with Stent Retriever Alone: A Single-Center Retrospective Analysis.
作者信息
Tsunogae Marie, Fujiwara Satoru, Ohara Nobuyuki, Murakami Yasutaka, Maekawa Kota, Fukumitsu Ryu, Goto Masanori, Imamura Hirotoshi, Kawamoto Michi, Sakai Nobuyuki
机构信息
Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
出版信息
J Neuroendovasc Ther. 2022;16(6):287-293. doi: 10.5797/jnet.oa.2021-0063. Epub 2021 Sep 30.
OBJECTIVE
The first pass effect (FPE), which means the achievement of complete or near-complete reperfusion of large vessel occlusion (LVO) in the first pass, is one of the goals of mechanical thrombectomy (MT). However, the impact of FPE on the prognosis has not been assessed for Japanese patients with various degrees of independence before the onset of LVO. The purpose of this study was to investigate the prognostic effects of FPE in a comprehensive stroke center in Japan, which includes patients in a variety of self-independence states with different comorbidities before stroke onset.
METHODS
Between April 2017 and March 2020, 151 patients who underwent MT with a stent retriever (SR) alone as initial strategy for anterior circulation (internal carotid artery terminal, M1, M2) LVO at our hospital and finally achieved modified treatment in cerebral infarction (mTICI) 2b-3 were analyzed. Forty-eight patients in whom first pass mTICI 2c-3 was achieved were classified into the FPE+ group, and the other 103 patients were classified into the FPE- group. We compared the characteristics and clinical outcomes between patients with and without FPE, and estimated the odds ratio for outcomes after adjusting for confounders.
RESULTS
The puncture-reperfusion time was shorter (20 vs. 35 minutes; p <0.01), and cardiogenic embolism was more common (81.3 vs. 60.2%; p = 0.01) in the FPE+ group. The FPE was significantly associated with good neurological outcome after 3 months (p <0.01; adjusted odds ratio [aOR], 3.87; 95% confidence interval [CI], 1.69-9.38), reduction in all intracranial hemorrhage (p <0.01; aOR, 0.24; 95% CI, 0.10-0.54), and symptomatic intracranial hemorrhage (p = 0.04; aOR, 0.16; 95% CI, 0.01-0.98).
CONCLUSION
The FPE with an SR alone improved the neurological prognosis in a Japanese patient group.
目的
首次通过效应（FPE）是指首次通过时实现大血管闭塞（LVO）的完全或接近完全再灌注，是机械取栓术（MT）的目标之一。然而，对于日本不同程度独立状态的LVO患者，FPE对预后的影响尚未得到评估。本研究的目的是在日本的一个综合卒中中心调查FPE的预后影响，该中心纳入了卒中发作前具有不同合并症的各种自主状态的患者。
方法
2017年4月至2020年3月期间，对我院151例接受单纯支架取栓器（SR）作为前循环（颈内动脉末端、M1、M2）LVO初始策略并最终实现改良脑梗死治疗（mTICI）2b-3的患者进行分析。48例首次通过实现mTICI 2c-3的患者被分类为FPE+组，其他103例患者被分类为FPE-组。我们比较了有FPE和无FPE患者的特征和临床结局，并在调整混杂因素后估计结局的比值比。
结果
FPE+组的穿刺-再灌注时间较短（20分钟对35分钟；p<0.01），心源性栓塞更常见（81.3%对60.2%；p=0.01）。FPE与3个月后良好的神经功能结局显著相关（p<0.01；调整后的比值比[aOR]，3.87；95%置信区间[CI]，1.69-9.38），所有颅内出血减少（p<0.01；aOR，0.24；95%CI，0.10-0.54），以及症状性颅内出血（p=0.04；aOR，0.16；95%CI，0.01-0.98）。
结论
单纯使用SR的FPE改善了日本患者组的神经预后。
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