Switch Strategy from Direct Aspiration First Pass Technique to Solumbra Improves Technical Outcome in Endovascularly Treated Stroke
| Autor: | Luca Bertaccini, Claudio Gasperini, Alberto Pingi, Alessandro Stasolla, Enrico Cotroneo, Valeria Cozzolino, Marilena Mangiardi, Sebastiano Fabiano, Gianluca De Rubeis, Enrico Pampana, Sabrina Anticoli |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
thrombolysis Health Toxicology and Mutagenesis medicine.medical_treatment Revascularization Single Center Article Brain Ischemia 030218 nuclear medicine & medical imaging Cohort Studies 03 medical and health sciences cerebrovascular 0302 clinical medicine Internal medicine medicine Odd ratio Humans mechanical Stroke Retrospective Studies First pass aspiration treatment Cerebral infarction business.industry Public Health Environmental and Occupational Health Thrombolysis medicine.disease stroke Treatment Outcome thrombectomy Cardiology outcome business 030217 neurology & neurosurgery Cohort study |
| Zdroj: | International Journal of Environmental Research and Public Health Volume 18 Issue 5 |
| ISSN: | 1660-4601 1661-7827 |
| Popis: | Background: The major endovascular mechanic thrombectomy (MT) techniques are: Stent-Retriever (SR), aspiration first pass technique (ADAPT) and Solumbra (Aspiration + SR), which are interchangeable (defined as switching strategy (SS)). The purpose of this study is to report the added value of switching from ADAPT to Solumbra in unsuccessful revascularization stroke patients. Methods: This is a retrospective, single center, pragmatic, cohort study. From December 2017 to November 2019, 935 consecutive patients were admitted to the Stroke Unit and 176/935 (18.8%) were eligible for MT. In 135/176 (76.7%) patients, ADAPT was used as the first-line strategy. SS was defined as the difference between first technique adopted and the final technique. Revascularization was evaluated with modified Thrombolysis In Cerebral Infarction (TICI) with success defined as mTICI ≥ 2b. Procedural time (PT) and time to reperfusion (TTR) were recorded. Results: Stroke involved: Anterior circulation in 121/135 (89.6%) patients and posterior circulation in 14/135 (10.4%) patients. ADAPT was the most common first-line technique vs. both SR and Solumbra (135/176 (76.7%) vs. 10/176 (5.7%) vs. 31/176 (17.6%), respectively). In 28/135 (20.7%) patients, the mTICI was ≤ 2a requiring switch to Solumbra. The vessel’s diameter positively predicted SS result (Odd Ratio [OR] 1.12, Confidence of Interval [CI] 95% 1.03–1.22 p = 0.006). The mean number of passes before SS was 2.0 ± 1.2. ADAPT to Solumbra improved successful revascularization by 13.3% (107/135 (79.3%) vs. 125/135 (92.6%)). PT was superior for SS comparing with ADAPT (71.1 min (CI 95% 53.2–109.0) vs. 40.0 min (CI 95% 35.0–45.2) p = 0.0004), although, TTR was similar (324.1 min (CI 95% 311.4–387.0) vs. 311.4 min (CI 95% 285.5–338.7) p = 0.23). Conclusion: Successful revascularization was improved by 13.3% after switching form ADAPT to Solumbra (final mTICI ≥ 2b was 92.6%). Vessel’s diameter positively predicted recourse to SS. |
| Databáze: | OpenAIRE |
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