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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Effect of Pathogenesis-Based Individualized Thrombectomy on Treatment Result and Prognosis of Acute Intracranial
Yong-Chang Liu1, Ming-Ming Zheng, Yan Li
1Cangzhou Central Hospital, Department of Neurovascular Intervention, Cangzhou City 061000, Hebei Province, China.
Insights
Direct aspiration first pass technique (ADAPT) reduces revascularization time in acute stroke. Stent use improves vessel patency after thrombectomy for cerebral infarction, enhancing patient prognosis.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Acute intracranial large-artery occlusion presents a critical challenge in stroke management.
- Timely and effective reperfusion is paramount for improving clinical outcomes.
- Individualized treatment strategies based on stroke etiology are increasingly important.
Purpose of the Study:
- To evaluate the impact of pathogenesis-based individualized thrombectomy on clinical outcomes.
- To compare the efficacy of direct aspiration first pass technique (ADAPT) versus stent thrombectomy.
- To assess the influence of different thrombectomy techniques on prognosis in acute stroke.
Main Methods:
- A prospective study involving 151 patients with acute intracranial large-artery occlusion.
- Patients were categorized into three groups: control (stent thrombectomy), ADAPT, and stent (stent thrombectomy or combined approach).
- Key metrics analyzed included time to revascularization, National Institutes of Health Stroke Scale (NHISS) scores, and modified Rankin Scale (mRS) scores at three months.
Main Results:
- The ADAPT group demonstrated a significant reduction in the time from arteriography to revascularization compared to the control group (p < 0.05).
- A significant increase in the patency rate after a single thrombectomy was observed in the ADAPT group (p < 0.05).
- Both the stent and ADAPT groups showed a significantly higher positive prognosis rate compared to the control group (p < 0.05).
Conclusions:
- Direct aspiration first pass technique (ADAPT) effectively reduces revascularization time in embolism-induced cerebral infarction.
- Stent utilization in atherosclerosis-induced cerebral infarction enhances the patency rate following a single thrombectomy.
- Pathogenesis-based individualized thrombectomy strategies improve clinical results and prognoses in acute stroke.
Aim:
To explore the effect of pathogenesis-based individualised thrombectomy on the clinical results and prognoses of acute intracranial large-artery occlusion.
Material And Methods:
A total of 151 patients were included in this prospective study and divided into the control group (stent thrombectomy, 53 cases), a direct aspiration first pass technique (ADAPT) group (52 cases) and the stent group (stent thrombectomy or a combination of stent thrombectomy and ADAPT, 46 cases) based on whether stent or ADAPT was used. We compared and analysed the patients? general information, the National Institutes of Health Stroke Scale (NHISS) score at admission, the time between the end of arteriography and revascularisation, the number of thrombectomies, the modified Rankin scale (mRS) score at three months and complications in the three groups.
Results:
Compared with the control group, the time between the end of arteriography and revascularisation in the ADAPT group was significantly reduced (p < 0.05), and the patency rate after one thrombectomy significantly increased (p < 0.05). The positive prognosis rate was significantly increased in the stent and ADAPT groups compared with the control group (p < 0.05).
Conclusion:
The application of the ADAPT technique in patients with embolism-induced cerebral infarction can reduce the time of revascularisation. The use of stents in patients with atherosclerosis-induced cerebral infarction can increase the patency rate after one thrombectomy.
