First pass effect with contact aspiration and stent retrievers in the Aspiration versus Stent Retriever (ASTER) trial
First pass effect with contact aspiration and stent retrievers in the Aspiration versus Stent Retriever (ASTER) trial
复制标题
DOI：
10.1136/neurintsurg-2019-015215
复制
发表时间：
2020-04-01
影响因子：
4.8
通讯作者：
Fahed, Robert
中科院分区：
文献类型：
--
作者：
Ducroux, Celina;Piotin, Michel;Fahed, Robert
背景最初描述的支架回收器的“首过效应”（FPE）指的是在单次器械通过后获得的（接近）完全血运重建，无需补救治疗，我们报告了FPE在抽吸与支架取栓器（ASTER）中的发生率和获益。试验.材料和方法ASTER是一项随机试验，比较了用支架回收器（SR）和接触抽吸（CA）血栓切除术技术进行血管造影再血管化，由外部核心实验室使用改良的脑梗死溶栓（mTICI）量表进行评估。比较了接受SR和CA技术治疗的患者的FPE发生率（定义为单次通过后mTICI 2c/3，无补救治疗）。结果336例患者中，97例获得FPE（28.9%），SR与CA之间无显著性差异（分别为53/169例患者（31.3%）vs 44/167例患者（26.3%），CA vs SR的校正RR 0.84，95% CI 0.54 - 1.31; p=0.44）。经过预先设定的调整分配臂和随机分层因素，FPE患者与一个显着改善的临床结局和死亡率降低，出血性转化和手术并发症的发生率显着低于non-FPE patients.ConclusionIn ASTER试验，类似的FPE率与SR和CA，FPE与一个显着改善的结果。新的技术和设备，以提高FPE率是必要的。
BackgroundThe 'first pass effect' (FPE), which was originally described with stent retrievers, designates a (near-)complete revascularization obtained after a single device pass with no rescue therapy, and is associated with improved clinical outcome and decreased mortality.ObjectiveWe report the rate and benefits of FPE in the Aspiration versus Stent Retriever (ASTER) trial.Materials and methodsASTER is a randomized trial comparing angiographic revascularization with the stent retriever (SR) and contact aspiration (CA) thrombectomy techniques, assessed by an external core laboratory using the modified Thrombolysis in Cerebral Infarction (mTICI) scale. Rates of FPE (defined by mTICI 2c/3 after a single pass with no rescue therapy) were compared between patients treated with SR and CA techniques. Outcomes were compared between FPE-SR and FPE-CA patients, and between FPE and non-FPE patients.ResultsFPE was achieved in 97/336 patients (28.9%), with no significant difference between SR and CA (respectively 53/169 patients (31.3%) vs 44/167 patients (26.3%), adjusted RR for CA versus SR 0.84, 95% CI 0.54 to 1.31; p=0.44). After prespecified adjustment for allocated arm and randomization stratification factors, FPE in patients was associated with a significantly improved clinical outcome and a decreased mortality, and a significantly lower rate of hemorrhagic transformation and procedural complications than in non-FPE patients.ConclusionIn the ASTER trial, similar rates of FPE were achieved with SR and CA, and FPE was associated with a significantly improved outcome. New techniques and devices to improve the rate of FPE are warranted.