Increased Success of Single-Pass Large Vessel Recanalization Using a Combined Stentriever and Aspiration Technique: A Single Institution Study
Increased Success of Single-Pass Large Vessel Recanalization Using a Combined Stentriever and Aspiration Technique: A Single Institution Study
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DOI：
10.1016/j.wneu.2018.12.023
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发表时间：
2019-03-01
影响因子：
2
通讯作者：
Duckwiler, Gary
中科院分区：
文献类型：
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作者：
Colby, Geoffrey P.;Baharyandat, Humain;Duckwiler, Gary
背景：大量证据支持使用支架取栓器（SR）对急性大血管闭塞（aLVO）进行机械取栓。抽吸也被用作取栓过程中的首次通过或辅助技术。在此我们报告对aLVO使用单独的SR、单独抽吸（AD）或SR与抽吸相结合（SA）作为首次通过的机械取栓病例的技术结果。
方法：对一个机构的卒中数据库进行回顾，纳入2011年至2017年期间在一家学术机构就诊的前循环aLVO患者，这些患者接受了机械取栓治疗。确定了单独使用SR、AD或这两种技术相结合（SA）进行治疗的患者。比较了三组首次取栓尝试后的成功再通率。
结果：共分析了353例患者，其中SR组215例，AD组32例，SA组106例。各组之间年龄和入院时美国国立卫生研究院卒中量表评分无显著差异。首次通过后的成功再通率在SR组为35.8%，首次通过技术采用抽吸时为34.4%，在SA组为55.7%，SA组首次通过成功率在统计学上显著更高（P = 0.002）。在SR组中使用球囊引导导管使首次通过成功再通率从21.3%翻倍至41.6%（P = 0.005）；然而，与SR和球囊引导导管组合相比，SA技术在首次通过再通方面更有效（55.7%对41.6%，P = 0.025）。
结论：与单独使用这些技术相比，SR和导管抽吸相结合可提高单次通过成功再通的比率。
BACKGROUND: Extensive evidence supports mechanical thrombectomy using stentrievers (SR) for acute large vessel occlusion (aLVO). Aspiration is also used as a first pass or adjunct technique during clot removal. Here we report technical results from mechanical thrombectomy cases using SR alone, aspiration alone (AD), or a combination of SR and aspiration (SA) as a first pass for aLVO.METHODS: An institutional stroke database was reviewed for patients presenting to a single academic institution with anterior circulation aLVO and who were treated with mechanical thrombectomy from 2011 to 2017. Patients managed with SR alone, AD, or a combination of these 2 techniques (SA) were identified. The rate of successful recanalization after the first thrombectomy attempt was compared between the 3 groups.RESULTS: A total of 353 patients were analyzed, including 215 in SR, 32 in AD, and 106 in SA groups. There was no significant difference for age and admission National Institutes of Health Stroke Scale between the groups. Successful recanalization rates after the first pass were 35.8% in the SR group, 34.4% in aspiration as a first pass technique, and 55.7% in SA, with a statistically significant higher rate of first pass success in the SA group (P = 0.002). Using balloon-guide catheter doubled the rate of successful first pass recanalization from 21.3% to 41.6% in the SR group (P = 0.005); however, the SA technique was more effective for first pass recanalization when compared with an SR and balloon-guide catheter combination (55.7% vs. 41.6%, P = 0.025).CONCLUSIONS: The combination of SR and catheter aspiration can increase the rate of single pass successful recanalization compared with these techniques individually.