Lessons Learned Over More than 500 Stroke Thrombectomies Using ADAPT With Increasing Aspiration Catheter Size
Lessons Learned Over More than 500 Stroke Thrombectomies Using ADAPT With Increasing Aspiration Catheter Size
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DOI：
10.1093/neuros/nyy444
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发表时间：
2020-01-01
期刊：
影响因子：
4.8
通讯作者：
Spiotta, Alejandro
中科院分区：
文献类型：
--
作者：
Alawieh, Ali;Chatterjee, A. Rano;Spiotta, Alejandro
背景：血管内血栓切除术目前是急性缺血性卒中（AIS）的标准治疗。虽然早期的血管内血栓切除术试验使用支架取栓器进行，但最近完成的接触抽吸与支架取栓器成功血运重建（ASTER）试验以及直接抽吸与支架取栓器作为首选方法（COMPASS）试验的比较显示了直接抽吸的非劣效性。目的：报告ADAPT血栓切除术的最大经验，并比较再灌注导管技术进步对结局的影响。我们回顾了2013年1月至2017年11月在南卡罗来纳州医科大学接受ADAPT血栓切除术的AIS患者的回顾性数据库。人口统计学和基线特征，技术变量，放射学和临床outcomesreviewed.RESULTS：在510例患者（平均年龄：67.7，50.6%女性），成功再通在第一次通过实现在61.8%，与抽吸仅在77.5%。平均手术时间为27.4 min，90 d时良好结局（mRS 0-2）率为42.9%。与较小导管（5 MAX和ACE，P <0.05）相比，使用较大导管（ACE 064和ACE 068）治疗的患者仅抽吸的再通率显著更高，手术时间显著更短。各组之间的并发症发生率或术后实质出血没有差异（P > 0.05）;然而，多变量回归分析显示，使用ACE 068是90 d时良好结局的独立预测因素（比值比= 1.6，P < .05）。结论：通过采用内径更大的再灌注导管和更高的抽吸力来完善ADAPT血栓切除术，结局、手术时间更短、使用额外器械的可能性更低，而不会影响并发症发生率。
BACKGROUND: Endovascular thrombectomy is currently the standard of care for acute ischemic stroke (AIS). Although earlier trials on endovascular thrombectomy were performed using stent retrievers, recently completed the contact aspiration vs stent retriever for successful revascularization (ASTER) and a comparison of direct aspiration versus stent retriever as a first approach (COMPASS) trials have shown the noninferiority of direct aspiration.OBJECTIVE: To report the largest experience with ADAPT thrombectomy and compare the impact of advancement in reperfusion catheter technologies on outcomes.METHODS: We reviewed a retrospective database of AIS patients who underwent ADAPT thrombectomy between January 2013 and November 2017 at the Medical University of South Carolina. Demographics and baseline characteristics, technical variables, and radiological and clinical outcomes were reviewed.RESULTS: Among 510 patients (mean age: 67.7, 50.6% females), successful recanalization at first pass was achieved in 61.8%, and with aspiration only in 77.5%. Mean procedure time was 27.4 min, and the rate of good outcomes (mRS 0-2) at 90 d was 42.9%. The rate of recanalization with aspiration only was significantly higher, and procedure time was significantly lower in patients treated with larger catheters (ACE 064 and ACE 068) compared to smaller catheters (5 MAX and ACE, P < .05). There were no differences in complication rates or postoperative parenchymal hemorrhage across groups (P > .05); however, use of ACE 068 was an independent predictor of good outcomes at 90 d on multivariate regression analysis (odds ratio = 1.6, P < .05).CONCLUSION: Refinement of ADAPT thrombectomy by incorporating reperfusion catheters with higher inner diameters and thus higher aspiration forces is associated with better outcomes, shorter procedure times, and lower likelihood of using additional devices without impacting complication rates.