ASTER2 试验中颈内动脉终末段或大脑中动脉闭塞的联合技术。

Combined Technique for Internal Carotid Artery Terminus or Middle Cerebral Artery Occlusions in the ASTER2 Trial.

机构信息

Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France (A.S., B.L., A.C.).

Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., M.P.).

出版信息

Stroke. 2024 Feb;55(2):376-384. doi: 10.1161/STROKEAHA.123.045227. Epub 2023 Dec 21.

DOI:10.1161/STROKEAHA.123.045227

PMID:38126181

Abstract

BACKGROUND

The aim of this study was to report the results of a subgroup analysis of the ASTER2 trial (Effect of Thrombectomy With Combined Contact Aspiration and Stent Retriever vs Stent Retriever Alone on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion) comparing the safety and efficacy of the combined technique (CoT) and stent retriever as a first-line approach in internal carotid artery (ICA) terminus±M1-middle cerebral artery (M1-MCA) and isolated M1-MCA occlusions.

METHODS

Patients enrolled in the ASTER2 trial with ICA terminus±M1-MCA and isolated M1-MCA occlusions were included in this subgroup analysis. The effect of first-line CoT versus stent retriever according to the occlusion site was assessed on angiographic (first-pass effect, expanded Treatment in Cerebral Infarction score ≥2b50, and expanded Treatment in Cerebral Infarction score ≥2c grades at the end of the first-line strategy and at the end of the procedure) and clinicoradiological outcomes (24-hour National Institutes of Health Stroke Scale, ECASS-III [European Cooperative Acute Stroke Study] grades, and 3-month modified Rankin Scale).

RESULTS

Three hundred sixty-two patients were included in the postsubgroup analysis according to the occlusion site: 299 were treated for isolated M1-MCA occlusion (150 with first-line CoT) and 63 were treated for ICA terminus±M1-MCA occlusion (30 with first-line CoT). Expanded Treatment in Cerebral Infarction score ≥2b50 (odds ratio, 11.83 [95% CI, 2.32-60.12]) and expanded Treatment in Cerebral Infarction score ≥2c (odds ratio, 4.09 [95% CI, 1.39-11.94]) were significantly higher in first-line CoT compared with first-line stent retriever in patients with ICA terminus±M1-MCA occlusion but not in patients with isolated M1-MCA.

CONCLUSIONS

First-line CoT was associated with higher reperfusion grades in patients with ICA terminus±M1-MCA at the end of the procedure.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03290885.

摘要

背景

本研究旨在报告 ASTER2 试验（血栓切除术联合接触抽吸和支架取栓与单独支架取栓治疗急性缺血性卒中和大血管闭塞患者的血管再通效果比较）亚组分析的结果，比较联合技术（CoT）和支架取栓作为颈内动脉（ICA）末端±M1-大脑中动脉（M1-MCA）和孤立的 M1-MCA 闭塞的一线治疗方法的安全性和有效性。

方法

纳入 ASTER2 试验中 ICA 末端±M1-MCA 和孤立的 M1-MCA 闭塞的患者进行本亚组分析。根据闭塞部位评估一线 CoT 与支架取栓的效果，通过血管造影（初次通过效果、扩展治疗脑梗死评分≥2b50 和扩展治疗脑梗死评分≥2c 级在一线策略结束时和手术结束时）和临床放射学结果（24 小时 NIHSS、ECASS-III[欧洲合作急性卒中研究] 分级和 3 个月 mRS）评估。

结果

根据闭塞部位，362 例患者纳入了亚组后分析：299 例治疗孤立的 M1-MCA 闭塞（150 例一线 CoT），63 例治疗 ICA 末端±M1-MCA 闭塞（30 例一线 CoT）。ICA 末端±M1-MCA 闭塞患者中，初次通过效果扩展治疗脑梗死评分≥2b50（优势比，11.83[95%CI，2.32-60.12]）和扩展治疗脑梗死评分≥2c（优势比，4.09[95%CI，1.39-11.94]）显著高于一线 CoT 与一线支架取栓相比，但孤立的 M1-MCA 闭塞患者中没有这种差异。