RECO支架与Solitaire支架对急性前循环大血管闭塞血管再通的疗效及安全性对比研究

doi:10.3969/j.issn.1673-5765.2021.12.006

摘要/Abstract

摘要： 目的比较急性前循环大血管闭塞性缺血性卒中采用RECO支架与Solitaire支架取栓治疗的有效性及安全性。方法回顾性分析2019年1月-2020年5月西安交通大学第一附属医院连续收治的行血管内支架取栓治疗的急性前循环大血管闭塞性缺血性卒中患者的临床资料。根据患者选用的支架类型将其分为 RECO支架治疗组和Solitaire支架治疗组。比较两组患者的基线资料，治疗有效性指标（血管成功再通率、首次取栓再通率、穿刺至手术结束时间及90 d良好预后率），以及安全性指标（术后24 h症状性颅内出血，术后24 h和90 d的全因死亡率）的差异。结果最终纳入81例急性前循环大血管闭塞性缺血性卒中患者，平均年龄64.0±12.0岁，男性57 例（70.4%）；RECO支架治疗组42例，Solitaire支架治疗组39例。两组患者年龄、性别分布、基线NIHSS 评分、ASPECTS评分，高血压、心房颤动、糖尿病、缺血性卒中或TIA病史比例，随机血糖、血小板计数、入院时Hcy、收缩压水平，以及闭塞部位、串联病变、桥接治疗比例和全身麻醉比例差异均无统计学意义。RECO支架治疗组与Solitaire支架治疗组术后血管成功再通率（88.1% vs. 82.1%）、首次取栓再通率（28.6% vs . 38.5%）、穿刺至手术结束时间（95.6±12.3 min vs . 92.5±14.2 mi n）、术中血栓逃逸率（11.9% vs . 15.4%）、夹层样病变发生率（4.8% vs . 2.6%）及术后24 h症状性颅内出血（14.3% vs. 10.3%）、24 h全因死亡率（7.1% vs. 5.1%）、90 d全因死亡率（19.0% vs. 17.9%）及90 d良好预后率（57.1% vs. 46.2%）差异均无统计学意义。结论 RECO支架治疗急性前循环大血管闭塞性缺血性卒中安全有效，其治疗效果及安全性与 Solitaire支架无明显差异。

文章导读： 本研究为RECO支架上市后首项在真实世界中用于急性前循环大血管闭塞治疗的单中心回顾性研究，结果表明RECO支架在血管内治疗有效性及安全性方面均不劣于Solitaire支架的脑血流恢复装置。

关键词: RECO支架; 前循环缺血性卒中; 大血管闭塞; 机械取栓

Abstract: Objective To compare the efficacy and safety of RECO flow restoration device and Solitaire stent for acute large vessel occlusion in anterior circulation. Methods This retrospective study enrolled the patients with acute anterior circulation large vessel occlusion stroke who received mechanical thrombectomy with stent retrievers from the First Hospital Affiliated to Xi’an Jiaotong University between January 2019 to May 2020, and the patients were divided into observation group (RECO stent) and control group (Solitaire stent). The baseline data, effectiveness indicators (successful recanalization rate, first-pass recanalization rate, time from puncture to end of operation, good prognosis at 90 days) and safety indicators (symptomatic intracranial hemorrhage within 24 hours after procedure, all-cause death within 24 hours and 90 days) between the two groups were compared.

Results A total of 81 patients were enrolled in this study, with a mean age of 64.0±12.0 years and

57 males (70.4%), 42 cases in observation group and 39 cases in control group. There were no statistical differences between the two groups in age, gender, baseline NIHSS score, ASPECTS score, proportion of hypertension, atrial fibrillation and diabetes, history of stroke or TIA, baseline blood glucose, platelet count, homocysteine level, baseline systolic blood pressure, occlusion site, tandem lesion, proportion of bridging therapy and general anesthesia (P >0.05). There were also no statistical differences between the two groups in successful recanalization rate (88.1% vs . 82.1%), first-pass recanalization rate (28.6% vs . 38.5%), time from puncture to end of operation (95.6±12.3 min vs . 92.5±14.2 min), thrombus escape rate (11.9% vs . 15.4%), arterial dissection rate (4.8% vs . 2.6%), the incidence of symptomatic intracranial hemorrhage within 24 hours (14.3% vs . 10.3%), all-cause mortality within 24 hours (7.1% vs . 5.1%) and 90 days (19.0% vs . 17.9%) and good prognosis rate at 90 days (57.1% vs . 46.2%). Conclusions The RECO stent retriever is an effective and safe flow restoration device for acute large vessel occlusion in anterior circulation stroke, which is comparable to Solitaire stent in efficacy and safety.

Key words: RECO stent; Anterior circulation ischemic stroke; Large vessel occlusion; Mechanical thrombectomy

刘福德, 陈晨, 宋文锋, 袁兴运, 韩建峰, 王建懿. RECO支架与Solitaire支架对急性前循环大血管闭塞血管再通的疗效及安全性对比研究[J]. 中国卒中杂志, 2021, 16(12): 1229-1234.

LIU Fude, CHEN Chen, SONG Wenfeng, YUAN Xingyun, HAN Jianfeng, WANG Jianyi. Comparative Efficacy and Safety of RECO Flow Restoration Device versus Solitaire Stent for Acute Large Vessel Occlusion in Anterior Circulation[J]. Chinese Journal of Stroke, 2021, 16(12): 1229-1234.

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