直接抽吸取栓术与机械支架取栓术在急性颅内血管闭塞中的疗效对比

Comparison of Efficacy of ADAPT Technology and Stent-retriever Thrombectomy in Acute Intracranial Vessel Occlusion

目的比较直接抽吸取栓术(a direct aspiration first-pass technique,ADAPT)与机械支架取栓术治疗急性颅内血管闭塞的有效性和安全性。方法回顾性纳入2019年3-12月于四川大学华西医院连续收治的急性颅内血管闭塞患者,根据采用手术方法不同将患者分为ADAPT组和支架组。血管成功再通定义为血流mTICI≥2b级,治疗技术相关指标为穿刺-血管再通时间、一次完全再通比例、一次完全再通手术时间、全部闭塞血管再通比例;主要疗效评价指标为90 d预后良好(mRS≤2分)比例;主要安全性评价指标为术中血栓逃逸与术后症状性颅内出血发生率。结果本研究最终纳入106例患者,年龄24~90岁,平均69.6±13.5岁,男性51例(48.1%);其中ADAPT组46例,支架组60例。ADAPT组中43例(93.5%)患者实现全部闭塞血管再通;支架组中52例(86.7%)患者实现全部闭塞血管再通。ADAPT组穿刺-血管再通时间短于支架组[52.5(31.5~87.7)min vs 64.0(51.0~98.7)min,P=0.036];一次完全再通时间短于支架组(37.2±12.4 min vs 59.5±21.4 mi n,P<0.001);两组一次完全再通、全部闭塞血管再通比例差异无统计学意义。ADAPT组90 d预后良好患者比例高于支架组(63.0%vs 36.7%,P=0.007);两组术中血栓逃逸及症状性颅内出血发生率差异无统计学意义。结论与支架组比较,采用ADAPT技术较支架取栓治疗急性颅内血管闭塞患者,手术时间更短,患者临床预后更佳。

Objective To compare the efficacy and safety of a direct aspiration first-pass thrombectomy(ADAPT)technology and stent-retriever thrombectomy for acute intracranial vessel occlusion.Methods This retrospective study enrolled the consecutive patients with acute intracranial vessel occlusion admitted to West China Hospital from March to December 2019,and all the patients were divided into stent group and ADAPT group according to surgical method.Successful recanalization was defined as mTICI 2b or 3 at end of procedure.Treatment technology related indexes included puncture to recanalization time,the percentage of one-time and total complete recanalization,the time of one-time complete recanalization.The efficacy indexes was the percentage of having a good prognosis(90-day mRS≤2 points),safety index included intraoperative thrombus escape and symptomatic intracranial hemorrhage post-procedure.The above indexes were compared between the two groups.Results A total of 106 patients were included,with a mean age of 69.6±13.5 years old(range:24-90 years old)and 51 males(48.1%),and 46 patients in ADAPT group and 60 patients in stent group.43 patients(93.5%)achieved complete recanalization in ADAPT group and 52 patients(86.7%)in stent group.The puncture to recanalization time was shorter in ADAPT group than in stent group[52.5(31.5-87.7)min vs 64.0(51.0-98.7)min,P=0.036];the time of one-time complete recanalization was shorter in ADAPT group than in stent group(37.2±12.4 min vs 59.5±21.4 min,P<0.001).There were no statistical difference in the percentage of one-time and total complete recanalization.The percentage of patients with good prognosis was higher in ADAPT group than in stent group(63.0%vs 36.7%,P=0.007).There was no statistical difference in the incidence of intraoperative thrombus escape and symptomatic intracranial hemorrhage between the two groups.Conclusions Compared to stent-retriever thrombectomy,ADAPT technology for acute intracranial vessel occlusion had a shorter operation time and better clinical efficacy.