可回收支架尺寸对于急性前循环大血管闭塞治疗效果的影响

doi:10.3969/j.issn.1673-5765.2018.04.011

摘要/Abstract

摘要：

目的在临床中，支架直径是影响血管内治疗的一个重要变量，但有关不同尺寸取栓支架选择的共识指南尚未建立。本研究在于探讨不同直径Solitaire可回收支架对急性卒中血管内治疗效果的影响。方法病例选自血管内治疗急性前循环缺血性卒中登记研究数据库。总共纳入628例使用Solitaire可回收支架进行急诊取栓的急性前循环大血管闭塞患者，其中256例使用直径6 mm Solitaire可回收支架， 372例使用4 mm支架。使用倾向性匹配分析方法对2种不同直径取栓支架组的患者进行匹配。血管开通率的评估使用改良脑梗死溶栓（modified Thrombolysis in Cerebral Infarction，mTICI）分级，90 d预后使用改良Rankin量表（modified Rankin Scale，mRS）评分，同时记录症状性出血及院内死亡率。结果进行倾向性评分匹配后，6 mm和4 mm两组支架患者比较，有效性和安全性差异无统计学意义。在动脉粥样硬化引起的大血管闭塞患者中，使用4 mm装置的患者血管开通率更高（P =0.021），用时更短（P =0.002），取栓次数更少（P =0.025）。对该部分患者术中血管开通率进行回归分析显示，使用小尺寸支架[比值比（odds ratio，OR）3.217，95%可信区间（confidence interval，CI）1.129～9.162，P =0.029] 以及倾向性得分（OR 52.84，95%CI 3.468～805.018，P =0.004）是成功开通的独立预测因素。结论本研究发现，没有证据表明Solitaire可回收支架的尺寸对血管内治疗结果有影响。对于动脉粥样硬化性大血管闭塞，使用小直径尺寸的支架具有更高的开通率。

关键词: 急性缺血性卒中; 可回收支架; 血管开通; 取栓

Abstract:

Objective In clinical practice, stent diameter was one of the variable properties which was an important factor for endovascular treatment. A consensus guideline for stent retriever size selection was yet to be established. The aim of this study was to investigate the effects of different diameter Solitaire retrievers on outcomes. Methods Of 628 patients enrolled from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry study’s database, 256 were treated with the Solitaire 6 mm device and 372 were treated with the 4 mm device. Patients treated with the two sizes of stent were matched by using propensity score analysis. The successful outcome was reperfusion as measured by the modified treatment in cerebral infarction (mTICI) grading immediately post procedure and the dichotomized modified Rankin Scale (mRS) score at 90 days. Symptomatic intracerebral hemorrhage and in hospital mortality were also recorded. Results After propensity score analysis, outcomes of the 6 mm group and 4 mm group were compared and there were no statistical difference in efficacy and safety. In addition, in patients with atherosclerotic-related occlusion, a higher reperfusion rate (P =0.021) was observed in the Solitaire 4 group, as well as a shorter time interval (P =0.002) and fewer passes (P =0.025). Independent predictors of successful reperfusion in patients with atherosclerotic disease on logistic analysis were small stent [odds ratio (OR) 3.217, 95% confidence interval (CI) 1.129-9.162, P =0.029] and propensity score acting as covariate (OR 52.84, 95%CI 3.468-805.018, P =0.004). Conclusion The study found no evidence for a differential effect of intra-arterial therapy with regard to the size of Solitaire retrievers. In patients with atheroscleroticlarge vessel occlusion, favorable reperfusion was associated with deployment of a small stent.

Key words: Acute ischemic stroke; Stent retriever; Reperfusion; Thrombectomy

杨东, 郝永岗, 资文杰, 王怀明, 郑德泉, 李华, 涂明义, 万跃, 金平, 肖国栋, 熊云云, 徐格林, 刘新峰. 可回收支架尺寸对于急性前循环大血管闭塞治疗效果的影响[J]. 中国卒中杂志, 2018, 13(04): 350-362.

YANG Dong, HAO Yong-Gang, ZI Wen-Jie, WANG Huai-Ming, ZHENG De-Quan, LI Hua, TU Ming-Yi, WAN Yue, JIN Ping, XIAO Guo-Dong, XIONG Yun-Yun, XU Ge-Lin, LIU Xin-Feng. Effect of Retrievable Stent Size on Treatment of Acute Anterior Circulation Large Vessel Occlusion[J]. Chinese Journal of Stroke, 2018, 13(04): 350-362.

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