Equal performance of aspiration and stent retriever thrombectomy in daily stroke treatment

被引：18

作者：

Bernsen, Marie Louise Elisabeth ^{[1
]}

Goldhoorn, Robert-Jan Berend ^{[2
]}

van Oostenbrugge, Robert J. ^{[2
]}

van Zwam, Wim H. ^{[3
]}

Uyttenboogaart, Maarten ^{[4
,5
]}

Roos, Yvo B. W. E. M. ^{[6
]}

Hofmeijer, Jeannette ^{[7
]}

Martens, Jasper M. ^{[1
]}

机构：

[1] Rijnstate Hosp, Dept Radiol, Arnhem, Netherlands

[2] Maastricht Univ, Med Ctr, Cardiovasc Res Inst Maastricht CARIM, Dept Neurol, Maastricht, Netherlands

[3] Maastricht Univ, Med Ctr, Cardiovasc Res Inst Maastricht CARIM, Dept Radiol, Maastricht, Netherlands

[4] Univ Groningen, Univ Med Ctr Groningen, Dept Neurol, Groningen, Netherlands

[5] Univ Groningen, Univ Med Ctr Groningen, Dept Radiol, Groningen, Netherlands

[6] Acad Med Ctr, Dept Neurol, Amsterdam, Netherlands

[7] Rijnstate Hosp, Dept Neurol, Arnhem, Netherlands

来源：

JOURNAL OF NEUROINTERVENTIONAL SURGERY | 2019年 / 11卷 / 07期

关键词：

stroke; thrombectomy; technique; device; ACUTE ISCHEMIC-STROKE; LARGE VESSEL OCCLUSION; 1ST PASS TECHNIQUE; ENDOVASCULAR TREATMENT; INTRAARTERIAL TREATMENT; INTRAVENOUS ALTEPLASE; RANDOMIZED-TRIAL; ADAPT TECHNIQUE; THERAPY; REVASCULARIZATION;

D O I：

10.1136/neurintsurg-2018-014270

中图分类号：

R445 [影像诊断学];

学科分类号：

100207 ;

摘要：

Background Mechanical thrombectomy with stent retrievers has proved to be safe and effective in endovascular treatment of acute ischemic stroke. Direct aspiration has shown revascularization rates comparable to those of stent retrievers in the recent ASTER and COMPASS trials. However, the efficacy of aspiration in routine clinical practice has not yet been shown. Objective To show that aspiration has clinical and technical outcomes equal to those of stent retriever thrombectomy in daily clinical practice. Methods We analysed data of patients with a large vessel occlusion of the anterior circulation registered in the Dutch MR CLEAN Registry between March 2014 and June 2016. Primary outcome was functional outcome measured with the modified Rankin Scale (mRS) score. Secondary outcomes were reperfusion grade, periprocedural complication rate, and procedure duration. Association of treatment technique with functional outcome was estimated with univariable and multivariable ordinal logistic regression analysis and expressed as a common OR (cOR) for a shift towards better outcome on the mRS. Results As first-line treatment, 207 of 1175 patients (17.6%) were treated with direct aspiration, and 968 (82.4%) by a stent retriever. We observed no differences in functional outcome (adjusted cOR=1.020 (95% CI 0.68 to 1.52)) and periprocedural complications. Successful reperfusion (extended Thrombolysis in Cerebral Infarction >= 2b) was similar. Duration of the procedure was shorter with aspiration (57 min (IQR 35-73) vs 70 min (IQR 47-95), p<0.0001). Conclusion Direct aspiration shows clinical outcomes equal to those of stent retriever thrombectomy in our large multicenter real-life cohort. We found no difference in complication rates and shorter procedure times for aspiration.

引用

页码：631 / +

页数：7

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