ADAPT联合SWIM取栓技术治疗急性大血管闭塞性卒中的临床研究

Clinical study of ADAPT combined with SWIM thrombectomy technique in the treatment of acute large vessel occlusive stroke

目的探讨首过直接抽吸技术(ADAPT)联合中间导管辅助可回收支架机械取栓术(SSWIM)治疗急性大血管闭塞性卒中(AIS-LVO)安全性及临床疗效。方法前瞻性连续纳入2020-01—2021-10就诊于茂名市人民医院AIS-LVO接受血管内治疗的患者共123例。按数字随机表法随机分配为联合技术组61例(给予ADAPT联合SWIM术)、单纯SWIM技术组62例(给予SWIM术),记录2组患者穿刺到再通时间、术后血管再通率采用改良脑梗死溶栓试验(mTICI)分级、术后90 d改良Rankin量表(m RS)评分等,并进行组间比较。同时对心源性栓塞卒中患者进行亚组分析。血管再通率采用mTICI分级进行评估,m TICI 2b-3级定义为血管成功再通;临床预后采用术后90 d mRS评分进行评估(mRS≤2分为预后良好)。结果联合技术组穿刺至血管再通时间为(56±30)min,较单纯SWIM技术组的(68±38)min更短,但差异无统计学意义(P=0.081)。2组的最终血管再通率分别为90.16(55/61)、90.2%(58/62),差异无统计学意义(P=0.443);术后90 d mRS≤2分分别为59.02%(36/61),32.26%(20/62),差异有统计学意义(P=0.005)。79例心源性栓塞卒中患者亚组分析显示,联合技术组与单纯SWIM技术组的血管再通率分别为87.5%(35/40)和87.5%(36/39)(P=0.311);平均穿刺至血管再通时间分别为(52±26)min、(59±31)min(P=0.331);术后90 d mRS≤2分分别为50%(20/40)、30.77%(12/39)(P=0.131),差异均无统计学意义(P>0.05)。结论ADAPT联合SWIM取栓技术治疗AIS-LVO安全有效,与单纯SWIM技术比较,可能使患者获得更好的临床预后。

Objective To explore the safety and clinical efficacy of a direct aspiration first pass technique(ADAPT)combined with stent retriever partially retracted with intermediate catheter for mechanical thrombectomy technique(SWIM)in the treatment of acute large vascular occlusive stroke.Methods Patients who were referred for endovascular treatment for acute ischemic stroke-large vessel occlusion(AIS-LVO)from January 2020 to October 2021 were continuously included.It was assigned randomly to the observation group(given ADAPT with SWIM),control group(given SWIM),record the puncture to reperfusion time,postoperative vascular recanaliza⁃tion rate using modified thrombolysis in cerebral infarction(mTICI)grade,modified Rankin scale(mRS)score,and compare between groups.Subgroup analysis of patients with cardioembolic stroke was also performed.Vascular recanalization rate was assessed by mTICI grade,and grade mTICI 2b-3 was defined as successful vascular recana⁃lization,clinical prognosis was assessed by 90 days postoperative mRS score(mRS 2 was a good outcome).Results A total of 123 patients with AIS-LVO were included,including 61 in the observation group and 62 in the control group.The puncture to reperfusion time in the observation group was(56±30)min,shorter min than in the control group(68±38)min,but not statistically significant(P=0.081).The finalreperfusion rate of both groups was 90.16(55/61),90.2%(58/62),insignificant(P=0.443),and the good outcome after 90d was 59.02%(36/61),32.26%(20/62)(P=0.005).Subgroup analysis of 79 patients with cardiac embolic stroke showed 87.5%(35/40)and 87.5%(36/39)(P=0.311),mean puncture to reperfusion time was(52±26)min,(59±31)min(P=0.331)and 50%(20/40),30.77%(12/39)(P=0.131).Conclusion ADAPT combined with SWIM thrombectomy technique is safe and effective in treating AIS-LVO,and the comparison with SWIM technique alone may provide patients with better clinical outcomes.