Zhiqiang Peng, Junchen Chen, Wenying Cao, Dongqing Zhao, Mi Ma, Qiaowei Li, Zhenzhen Zhu, Wanyi He, Biqing Yang, Minqi Cao
Department of Stroke Center, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China.
Department of Neurosurgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, Guangdong, China.
Front Neurol. 2024 Jan 15;14:1324725. doi: 10.3389/fneur.2023.1324725. eCollection 2023.
This study aims to compare the clinical efficacy of aspiration thrombectomy and stent retriever thrombectomy as first-line approaches for anterior circulation large vessel cardiogenic cerebral embolism and cryptogenic stroke.
This retrospective observational study included patients with anterior circulation large vessel cardiogenic cerebral embolism and cryptogenic stroke treated with endovascular therapy. Patients were grouped according to the first-line approach they received: aspiration thrombectomy or stent retriever thrombectomy. The primary outcome measure was the change in the National Institute of Health Stroke Scale (NIHSS) score from preoperative to immediate postoperative and from preoperative to discharge. Secondary indicators included the rate of favorable prognosis at discharge [Modified Rankin Scale (mRS) score ≤ 2], successful vessel recanalization rate [modified Treatment in Cerebral Ischemia (mTICI) score ≥ 2b], time from successful femoral artery puncture to successful vessel recanalization, and perioperative complications.
The study included 127 cases, with 1 case withdrawal after enrollment due to a stroke of another determined cause, with 83 in the aspiration thrombectomy group and 43 cases in the stent retriever thrombectomy group. The change in NIHSS score from preoperative to immediate postoperative was 5 (1, 8) in the aspiration thrombectomy group and 1 (0, 4.5) in the stent retriever thrombectomy group. The change from preoperative to discharge was 8 (5, 12) in the aspiration thrombectomy group and 4 (0, 9) in the stent retriever thrombectomy group. The aspiration thrombectomy group exhibited significantly better prognosis rates and shorter time from successful femoral artery puncture to successful vessel recanalization. There were no significant differences between the two groups in terms of successful vessel recanalization rates and perioperative complications.
As a first-line approach for anterior circulation large vessel cardiogenic cerebral embolism and cryptogenic stroke, aspiration thrombectomy leads to better improvement in neurological functional deficits and prognosis rates compared to stent retriever thrombectomy.
本研究旨在比较抽吸血栓切除术和支架取栓术作为前循环大血管心源性脑栓塞和隐源性卒中一线治疗方法的临床疗效。
这项回顾性观察性研究纳入了接受血管内治疗的前循环大血管心源性脑栓塞和隐源性卒中患者。根据患者接受的一线治疗方法进行分组：抽吸血栓切除术或支架取栓术。主要观察指标为术前至术后即刻以及术前至出院时美国国立卫生研究院卒中量表（NIHSS）评分的变化。次要指标包括出院时良好预后率[改良Rankin量表（mRS）评分≤2]、血管成功再通率[改良脑缺血治疗（mTICI）评分≥2b]、从成功股动脉穿刺到血管成功再通的时间以及围手术期并发症。
该研究共纳入127例患者，其中1例因另一种确定病因的卒中在入组后退出，抽吸血栓切除术组83例，支架取栓术组43例。抽吸血栓切除术组术前至术后即刻NIHSS评分的变化为5（1，8），支架取栓术组为1（0，4.5）。抽吸血栓切除术组术前至出院时的变化为8（5，12），支架取栓术组为4（0，9）。抽吸血栓切除术组的预后率显著更好，从成功股动脉穿刺到血管成功再通的时间更短。两组在血管成功再通率和围手术期并发症方面无显著差异。
作为前循环大血管心源性脑栓塞和隐源性卒中的一线治疗方法，与支架取栓术相比，抽吸血栓切除术能更好地改善神经功能缺损和预后率。
