对比分析抽吸取栓与支架取栓治疗前循环大血管急性栓塞性闭塞的临床疗效

目的对比分析导管抽吸取栓与支架取栓治疗前循环大血管急性栓塞性闭塞患者的临床疗效。 方法回顾性分析2021年1月至2022年1月于南京医科大学第一附属医院接受血管内治疗的前循环大血管急性栓塞性闭塞患者的临床资料。主要观察指标是90 d改良Rankin量表（modified Rankin scale，mRS）评分。采用独立样本t检验、Mann-Whitney U检验和卡方检验比较两组患者的临床资料。单因素和多因素逻辑回归分析评价临床预后的影响因素。 结果研究期间内共纳入120例患者，其中46例（38.3%）患者接受导管抽吸取栓，74例（61.7%）患者采用支架取栓。较支架取栓相比，抽吸取栓手术时间更短（36 min vs 46 min；Z = 928.5，P < 0.001），成功再通率（93.5% vs 75.7%；c² = 6.227，P = 0.014）、完全再通率（60.9% vs 40.5%；c² = 4.694，P = 0.039）。和90 d良好预后（mRS 0~2）比例更高（50.0% vs 31.1%；c² = 4.295，P = 0.038）。两组之间不良事件发生率（症状性脑出血和90 d死亡率）无明显差异。多因素逻辑回归分析显示抽吸取栓术和良好临床预后显著正相关（OR = 0.12，95%CI：0.03~0.49；P = 0.003）。 结论对于前循环大血管急性栓塞性闭塞患者，本单中心研究结果显示导管抽吸取栓优于支架取栓，但确切的结果还需更严格临床研究的验证。

Comparison of outcomes of aspiration thrombectomy and stent retriever thrombectomy in patients with acute embolic stroke due to large vessel occlusion

ObjectiveTo compare the angiographic and clinical outcomes between aspiration thrombectomy and stent retriever thrombectomy in patients with acute embolic stroke due to emergent large vessel occlusion (ELVO) in the anterior circulation. MethodsData from consecutive acute ischemic stroke (AIS) patients who treated by endovascular thrombectomy using aspiration thrombectomy or stent retriever thrombectomy in our hospital between January 2021 and January 2022 were retrospectively analyzed. The primary outcome was the 90-day modified Rankin scale (mRS) score. Procedure metrics and clinical outcomes were compared between these two groups. The risk factors associated with clinical outcome were determined by using univariate and multivariate logistic regression analyses. ResultsA total of 120 patients were included for further evaluation. Among them, primary aspiration thrombectomy was performed in 46 (38.3%) patients, and primary stent retriever thrombectomy was used in 74 (61.7%) patients. Median procedure time(36 vs 46 minutes; Z = 928.5, P < 0.001) were significantly shorter in patients treated with aspiration thrombectomy. Successful recanalization rates (93.5% vs 75.7%; c² = 6.227, P = 0.014), full recanalization rates (60.9% vs 40.5%; c² = 4.694, P = 0.039) and good clinical outcome (mRS 0~2) (50.0% vs 31.1%; c² =4.295, P = 0.038) were achieved in aspiration group significantly higher than those in stent retriever group. Adverse event rates, including symptomatic intracerebral hemorrhage and 90-day mortality were comparable between the two groups. Multivariable logistic regression analysis showed that aspiration thrombectomy was independently associated with good functional outcome (adjusted common odds ratio: 0.12, 95% confidence interval: 0.03~0.49, P = 0.003). ConclusionsAmong the specific patients with LVO due to acute embolic stroke, the use of aspiration thrombectomy approach compared with stent retriever thrombectomy resulted in a greater likelihood of favorable neurological outcomes. A large multicenter randomized clinical trial is warranted.