Predictors of the Aspiration Component Success of a Direct Aspiration First Pass Technique (ADAPT) for the Endovascular Treatment of Stroke Reperfusion Strategy in Anterior Circulation Acute Stroke
Predictors of the Aspiration Component Success of a Direct Aspiration First Pass Technique (ADAPT) for the Endovascular Treatment of Stroke Reperfusion Strategy in Anterior Circulation Acute Stroke
复制标题
DOI：
10.1161/strokeaha.116.016149
复制
发表时间：
2017-06-01
期刊：
影响因子：
8.3
通讯作者：
Piotin, Michel
中科院分区：
文献类型：
--
作者：
Blanc, Raphael;Redjem, Hocine;Piotin, Michel
背景和目的-据报道，直接抽吸首过技术（ADAPT）是治疗急性缺血性卒中的快速、安全和有效的方法。本研究的目的是确定术前因素，影响成功的抽吸部分的技术在缺血性中风患者与大血管闭塞的前循环。我们入组了2013年8月至2015年10月在我们机构接受机械血栓切除术并接受ADAPT治疗的所有347例前循环急性缺血性卒中患者，中风的治疗记录并分析基线和手术特征、改良的脑梗死溶栓评分和3个月改良的兰金量表。（闭塞部位：大脑中动脉200例，占58%，颈内动脉虹吸89例，占25%;串联= 58，17%），抽吸组件导致成功再灌注（脑梗死改良溶栓2b/ 3分）55.6%（193/347例患者），40%需要支架取栓器，最终再灌注总成功率为83%（288/347）。总体而言，13.3%的患者（48/347）发生了手术并发症。45%（144/323）报告90天时改良兰金量表评分为0 - 2分。只有2个因素对抽吸成功率有积极影响：孤立性大脑中动脉闭塞（P< 0.001）和从卒中发作到血栓接触的时间较短（P= 0.018）。结论：在这项大型回顾性研究中，ADAPT被证明对前循环急性缺血性卒中安全有效，最终成功再灌注率为83%。动脉闭塞部位和手术延迟是再灌注的预测因素。
Background and Purpose-A direct aspiration first pass technique (ADAPT) has been reported to be fast, safe, and effective for the treatment of acute ischemic stroke. The aim of this study is to determine the preoperative factors that affect success of the aspiration component of the technique in ischemic stroke patients with large vessel occlusion in the anterior circulation.Methods-We enrolled all 347 consecutive patients with anterior circulation acute ischemic stroke admitted for mechanical thrombectomy at our institution from August 2013 to October 2015 and treated by ADAPT for the endovascular treatment of stroke. Baseline and procedural characteristics, modified thrombolysis in cerebral infarction scores, and 3-month modified Rankin Scale were captured and analyzed.Results-Among the 347 patients (occlusion sites: middle cerebral artery= 200, 58%; internal carotid artery Siphon= 89, 25%; Tandem= 58, 17%), aspiration component led to successful reperfusion (modified thrombolysis in cerebral infarction 2b/ 3 scores) in 55.6% (193/347 patients), stent retrievers were required in 40%, and a total successful final reperfusion rate of 83% (288/347) was achieved. Overall, procedural complications occurred in 13.3% of patients (48/347). Modified Rankin Scale score of 0 to 2 at 90 days was reported in 45% (144/323). Only 2 factors positively influenced the success of the aspiration component: an isolated middle cerebral artery occlusion (P< 0.001) and a shorter time from stroke onset to clot contact (P= 0.018).Conclusions-In this large retrospective study, ADAPT was shown to be safe and effective for anterior circulation acute ischemic stroke with a final successful reperfusion achieved in 83%. The site of arterial occlusion and delay of the procedure were predictors for reperfusion.