日进一卒,功不唐捐。
今天是咱们一起学习的第 948天
这一回:【取栓简史】六、偶遇
为什么到现在为止,大家对于颅内闭塞再通后的支架植入依然慎重。支架植入明明可以增加再灌注率啊。说到底还是担心支架植入后继发血栓,需要双抗,又得担心出血转化。前有狼后有虎。所以能把血栓搞出来的器械才是更适合急性闭塞再通的器械。
上一期我们看到了Merci和Penumbra是被认可的取栓装置,但是再通率较低。这就有问题了,要么是技术不行,要么是该需要对装置进行改进。
但是究竟什么样的设计能够更加容易地拉出血栓呢?Solitaire这款可回收可释放的支架本来是用于治疗宽颈脑动脉瘤的颈部辅助支架。
在偶然的机会中,术者发现该设备可以部署在血栓闭塞处,实现立即恢复血流。如果把这支架收回来,还能把血栓带出体外。这个偶然的发现实在太奇妙了。
Castaño等报道了Solitaire AB在20例ICA和MCA LVO AIS患者血管重建中的安全性和有效性,这些患者都是在发病后8小时内的。90%的病例实现了成功的血运重建,远远高于以往报道的任何其他技术。
随后,其他几项研究报告了Solitaire AB和不可解离的Solitaire FR与其他支架样取栓装置(如Trevo“Stryker Neurovascular”和Revive“Codman Endovascular”回收装置)的取栓效果。结果都很令人满意,再通率都很高。
那就和老大哥Merci比比看!
两项随机临床试验表明,在血运重建的成功率和安全性方面,SR与Merci检索器相比具有优势。2012年,Saver等人在SWIFT (Solitaire With Intention for thromboectomy)试验中评估了Solitaire FR装置的安全性和有效性。
该试验报告了更高的再通率(69% vs 30%;P=0.0001)和较低的90天死亡率(17% vs 38%;P=0.02)。90天功能独立率较高,但无统计学意义(mRS评分0-2:44% vs 36%; P=0.53)。
同年,Nogueira等报道了Trevo与Merci在Trevo-2(急性缺血性脑卒中大血管闭塞的血栓切除血运重建)试验中的对比结果。在本研究中,88例患者随机分配使用Trevo,90例患者随机分配使用Merci组。
Trevo组的再通率(86% vs 60%;P<0.0001)和90天的功能独立性(40% vs 22%;P=0.013)显著高于Merci组。
取栓界的老大哥的地位被撼动了。
但是这不是目的。
我们的目的是撼动静脉溶栓的地位……
且看下一回
原著:
翻译:
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