抽吸取栓与支架取栓在急性缺血性卒中治疗中的研究进展

doi:10.3969/j.issn.1673-5765.2019.04.017

摘要/Abstract

摘要：

急性缺血性卒中血管内治疗是静脉溶栓后又一血管再通疗法，一线治疗技术为支架取栓，抽吸取栓是相对支架取栓的另一种技术。文章对抽吸取栓与支架取栓在急性缺血性卒中患者血管内治疗中的疗效进行综述。急性缺血性卒中血管内治疗目前仍以支架取栓作为一线技术，作为补充技术的抽吸取栓从股动脉穿刺到再灌注的时间较短，未来研究可能更着重于按特定部位或病因采取不同的取栓技术。

文章导读： 急性缺血性卒中血管内治疗的一线技术是支架取栓，但作为补充技术的ADAPT从股动脉穿刺到再灌注的时间较短，按特定部位或病因采取不同的取栓技术有待进一步研究。

关键词: 缺血性卒中; 大动脉闭塞; 血管内治疗; 抽吸取栓; 支架取栓; 疗效

Abstract:

Stent thrombectomy is the preferred way in endovascular treatment (EVT) for acute ischemic stroke (AIS) recommended by current guidelines. Aspiration thrombectomy is another EVT technology widely applied in acute reperfusion therapy after stent-retriever thrombectomy. This article reviewed the advance in effect analysis of two technologies for AIS. Now stent thrombectomy is still the first-line technology in stroke EVT, with aspiration thrombectomy as a supplementary therapy. Some studies indicated that aspiration thrombectomy had some particular advantages such as the puncture-to-reperfusion time was much more relatively shorter. Future research will focus on the EVT technology selection according to stroke etiology and the location of vessel occlusion.

Key words: Ischemic stroke; Large artery occlusion; Endovascular treatment; Aspiration; Stent retriever; Effect

王鹏，徐程华，应江鲜，王新量，王志敏. 抽吸取栓与支架取栓在急性缺血性卒中治疗中的研究进展[J]. 中国卒中杂志, 2019, 14(04): 381-384.

WANG Peng, XU Cheng-Hua, YING Jiang-Xian, WANG Xin-Liang, WANG Zhi-Min. Advance in Aspiration Thrombectomy and Stent-retriever Thrombectomy for Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2019, 14(04): 381-384.

参考文献

[1] MURRAY C J，LOPEZ A D. Global mortality，

disability，and the contribution of risk factors：

Global Burden of Disease Study[J]. Lancet，1997，

349（9063）：1436-1442.

[2] YANG G，WANG Y，ZENG Y，et al. Rapid health

transition in China，1990-2010：findings from the

Global Burden of Disease Study 2010[J]. Lancet，

2013，381（9882）：1987-2015.

[3] SILBERBERG D. Neurological disease on the global

agenda[J]. Ann Neurol，2008，64（4）：475-476.

[4] BERKHEMER O A，FRANSEN P S，BEUMER D，

et al. A randomized trial of intraarterial treatment

for acute ischemic stroke[J]. N Engl J Med，2015，372

（1）：11-20.

[5] GOYAL M，DEMCHUK A M，MENON B K，et

al. Randomized assessment of rapid endovascular

treatment of ischemic stroke[J]. J Engl J Med，2015，

372（11）：1019-1030.

[6] CAMPBELL B C，MITCHELL P J，KLEINIG T J，

et al. Endovascular therapy for ischemic stroke with

perfusion-imaging selection. [J]. N Engl J Med，2015，

372（11）：1009-1018.

[7] SAVER J L，GOYAL M，BONAFE A，et al. Stentretriever

thrombectomy after intravenous t-PA vs .

t-PA alone in stroke[J]. N Engl J Med，2015，372

（24）：2285-2295.

[8] JOVIN T G，CHAMORRO A，COBO E，et al.

Thrombectomy within 8 hours after symptom onset

in ischemic stroke[J]. N Engl J Med，2015，372（24）：

2296-2306.

[9] DEREX L，CHO T H. Mechanical thrombectomy in

acute ischemic stroke[J]. Rev Neurol（Paris），2017，

173（3）：106-113.

[10] GOYAL M，MENON B K，VAN ZWAM W H，et

al. Endovascular thrombectomy after large-vessel

ischaemic stroke：a meta-analysis of individual

patient data from five randomised trials[J]. Lancet，

2016，387（10029）：1723-1731.

[11] POWERS W J，DERDEYN C P，BILLER J，et al.

2015 American Heart Association/American Stroke

Association focused update of the 2013 guidelines for

the early management of patients with acute ischemic

stroke regarding endovascular treatment：a guideline

for healthcare professionals from the American Heart

Association/American Stroke Association[J]. Stroke，

2015，46（10）：3020-3035.

[12] CHAPOT R，HOUDART E，ROGOPOULOS A，et

al. Thromboaspiration in the basilar artery：report of

two cases[J]. AJNR Am J Neuroradiol，2002，23（2）：

282-284.

[13] JANKOWITZ B T，ALEU A，LIN R，et al.

Endovascular treatment of basilar artery occlusion by

manual aspiration thrombectomy[J]. J NeuroInterv

Surg，2010，2（2）：110-114.

[14] JANKOWITZ B，AGHAEBRAHIM A，ZIRRA A，

et al. Manual aspiration thrombectomy：adjunctive endovascular recanalization technique in acute

stroke interventions[J]. Stroke，2012，43（5）：1408-

1411.

[15] BOSE A，HENKES H，ALFKE K，et al. The

Penumbra System：a mechanical device for the

treatment of acute stroke due to thromboembolism[J].

AJNR Am J Neuroradiol，2008，29（7）：1409-1413.

[16] Penumbra Pivotal Stroke Trial Investigators.

The penumbra pivotal stroke trial：safety and

effectiveness of a new generation of mechanical

devices for clot removal in intracranial large vessel

occlusive disease[J]. Stroke，2009，40（8）：2761-

2768.

[17] MOCCO J，ZAIDAT O O，VON KUMMER R，et al.

Aspiration thrombectomy after intravenous alteplase

versus intravenous alteplase alone[J]. Stroke，2016，

47（9）：2331-2338.

[18] Gross B A，Jadhav A P，Jovin T G，et al. Dump

the pump：manual aspiration thrombectomy（MAT）

with a syringe is technically effective，expeditious，

and cost-efficient[J]. J Neurointerv Surg，2018，10

（4）：354-357.

[19] TURK A S，FREI D，FIORELLA D，et al. ADAPT

FAST study：a direct aspiration first pass technique

for acute stroke thrombectomy[J]. J Neuro Interv

Surg，2014，6（4）：260-264.

[20] TURK A S，SPIOTTA A，FREI D，et al. Initial

clinical experience with the ADAPT technique：a

direct aspiration first pass technique for stroke

thrombectomy[J]. J Neurointerv Surg，2014，6（3）：

231-237.

[21] LAPERGUE B，BLANC R，GUEDIN P，et al. A

Direct Aspiration，First pass technique（ADAPT）

versus stent retrievers for acute stroke therapy：an

observational comparative study[J]. AJNR Am J

Neuroradiol，2016，37（10）：1860-1865.

[22] KOWOLL A，WEBER A，MPOTSARIS A，et

al. Direct aspiration first pass technique for the

treatment of acute ischemic stroke：initial experience

at a European stroke center[J]. J Neurointerv Surg，

2016，8（3）：230-234.

[23] LAPERGUE B，BLANC R，GORY B，et al. Effect

of endovascular contact aspiration vs stent retriever

on revascularization in patients with acute ischemic

stroke and large vessel occlusion：the ASTER

randomized clinical trial[J]. JAMA，2017，318（5）：

443-452.

[24] PHAN K，DMYTRIW A A，TENG I，et al. A

direct aspiration first pass technique vs standard

endovascular therapy for acute stroke：a systematic

review and meta-analysis[J]. Neurosurgery，2017，83

（1）：19-28.

[25] BERNSEN M L E，GOLDHOORN R J B，VAN

OOSTENBRUGGE R J，et al. Equal performance of

aspiration and stent retriever thrombectomy in daily

stroke treatment[J/OL]. J Neurointerv Surg，2018.

https：//doi.org/10.1136/neurintsurg-2018-014270.

[26] TSANG C O A，CHEUNG I H W，LAU K K，et

al. Outcomes of stent retriever versus aspirationfirst

thrombectomy in ischemic stroke：a systematic

review and meta-analysis[J]. AJNR Am J

Neuroradiol，2018，39（11）：2070-2076.

[27] TURK A S，SIDDIQUI A H，MOCCO J. A

comparison of direct aspiration versus stent retriever

as a first approach（'COMPASS'）：protocol[J]. J

Neurointerv Surg，2018，10（10）：953-957.