| Background:The incidence of acute posterior circulation ischemic stroke accounts for about 20%of all acute ischemic strokes,often leading to serious consequences such as paralysis,coma and even death.Traditional drug treatments such as antiplatelet aggregation,anticoagulation,and intravenous thrombolysis are not effective for large vessel occlusive stroke in the posterior circulation,and the poor prognosis rate can reach to 80%.Endovascular Treatment(EVT)such as stent retriever,direct aspiration,balloon expansion,stent implantation and other technologies can quickly open occluded blood vessels and restore blood perfusion,thereby improving patient prognosis and reducing disability and mortality.A meta-analysis of five major studies of the anterior circulation published in 2016 showed that for anterior circulation large vessel occlusive stroke,endovascular treatment has a significant advantage in improving neurological function compared with traditional drugs and intravenous thrombolytic therapy,and subsequently the DAWN study extended the time window of endovascular treatment to24h.With the widly application of endovascular treatment and technological advancement,endovascular treatment has now become the first-line treatment for acute large-vessel occlusive stroke.For posterior circulation large vessel occlusive stroke,the BASICS study published in 2009 and the BEST study in 2019 failed to confirm that endovascular treatment has better efficacy and safety than traditional drugs and intravenous thrombolytic therapy.However,a large-scale multi-center prospective observational study recently published in China confirmed that endovascular therapy is significantly better than traditional drug therapy in terms of the efficacy and safety of posterior circulation large vessel occlusive stroke.The results of multiple meta-analyses published recently show that there is no significant difference in the efficacy and safety of endovascular treatment of large vessel occlusive stroke in anterior and posterior circulation.Endovascular therapy can quickly open occluded blood vessels and improve the survival rate of patients.It has now replaced drug therapy and intravenous thrombolysis and has become the main treatment for acute intracranial large vessel occlusive stroke.At present,the most important method for endovascular treatment of acute large vessel occlusive stroke is Stent Retriever Thrombectomy(SRT).A number of previously published clinical randomized controlled studies evaluating the efficacy and safety of endovascular treatment have also been carried out with stent retriever as the main treatment method.However,with the emergence of A Direct Aspiration first-Pass Thrombectomy(ADAPT),new ideas have been brought to the endovascular treatment of intracranial large vessel occlusive stroke.Different from stent retriever,direct aspiration setting a suction catheter along the vascular access to the thrombus,and draw the embolus out of the body under continuous negative pressure suction.The ASTER study(published in 2017)and the COMPASS study(published in 2019)are both large-scale clinical randomized controlled studies,and the results suggest that for patients receiving direct aspiration and stent retriever thrombectomy for anterior circulation large vessel occlusive stroke,there was no significant difference in the good prognosis and mortality at 90 days postoperatively,confirming the efficacy and safety of thrombus aspiration technology in anterior circulation large vessel occlusive stroke.The results of a number of recent meta-analysis showed that for the treatment of large vessel occlusive stroke in the posterior circulation,direct aspiration and stent retriever have similar efficacy and safety,but currently there is a lack of clinical randomized controlled studies to support the above conclusions.Objective:1.To observe the efficacy and safety of acute ischemic stroke caused by posterior circulation large vessel occlusion after endovascular treatment,and to analyze the factors that affect the clinical prognosis.2.To compare the efficacy and safety difference between stent retriever and direct aspiration on acute ischemic stroke caused by posterior circulation large vessel occlusion.Methods:1.A multi-center retrospective study on the efficacy and safety of endovascular treatment for acute posterior circulation large vessel occlusive stroke:To collected the baseline data and clinical data of patients with large posterior circulation vessel occlusive stroke in 9 stroke centers of the China southwestern region from January 2018 to August 2020,the main observation indicators are the 90-day modified Rankin Scale(m RS)score,postoperative modified Thrombolysis In Cerebral Infarction(m TICI)score,symptomatic Intracerebral Hemorrhage(s ICH),etc.According to the m RS score 90 days after surgery,patients were divided into a good prognosis group(m RS≤2 points)and a poor prognosis group(m RS>2points),using t/x~2Test to analyze the differences in baseline data and clinical data between the two groups of patients,and factors affecting clinical prognosis will be analyzed under subgroup concurrently.2.A comparative study on the efficacy and safety of two endovascular treatment techniques(direct aspiration vs stent retriever)in the treatment of acute stroke due to posterior circulation large vessel occlusion:a collection of 9 stroke centers in the southwest region from January 2018 to August 2020 Baseline data and clinical data of patients with posterior circulation large vessel occlusive stroke in emergency endovascular treatment.According to different surgical methods,the cases were divided into direct aspiration group and stent retriever group.Main observation indicators:(1)Curative effect indicators:Postoperative 90 d m RS score,m TICI score,vascular recanalization rate and vascular recanalization time,etc.;(2)Safety indicators:postoperative 90-day mortality,s ICH,etc.Comparing the clinical prognosis differences between the two treatment groups.Results:1.A multi-center retrospective study on the efficacy and safety of endovascular treatment for acute posterior circulation large vessel occlusive stroke:108 patients were enrolled.After follow-up 90 days after surgery,the good prognosis(m RS≤2)rate was 43.5%(47/108),the mortality rate was 25.9%(28/108),the vascular recanalization rate was 95.4%(103/108),and the symptomatic intracranial hemorrhage rate was 8.3%(9/108).Different prognosis groups in the preoperative and postoperative circulation Alberta Stroke Program Early CT Score(Pc-ASPECTS),National Institutes of Health Stroke Scale(NIHSS)score and Basilar Artery Computer Scanning Angiography(BATMAN)score,vascular recanalization rate,symptomatic intracranial hemorrhage and other indicators were significantly different(P<0.05).The results of subgroup analysis of multiple factors affecting clinical prognosis suggest that preoperative NIHSS scores,BATMAN and Pc-ASPECTS scores,and the degree of recanalization and recanalization time are the main factors affecting the prognosis,while some factors such as type of stroke,thrombus location,and bridging thrombolysis and anesthesia have no significant effect on clinical prognosis.2.A comparative study on the efficacy and safety of two endovascular treatment techniques(direct aspiration vs stent retriever)in the treatment of acute stroke due to posterior circulation large vessel occlusion:A total of 97 patients were enrolled,and the difference of the stroke types,preoperative scores,thrombus location and other indicators were not statistically significant(P>0.05),but the method of anesthesia(55.1%vs 25.0%,P=0.007),the average time from puncture to recanalization/min(91.3±25.9 vs 72.6±27.8,P=0.002),Intracranial hemorrhage(10.1%vs 28.6%,P=0.028)were statistically significant.After a90-day follow-up,the stent retriever group and the direct aspiration group had the same good prognosis rate(44.9%vs.42.9%,P=0.852)and mortality rate(27.5%vs.21.4%,P=0.553)in the primary endpoint.As well as the secondary endpoint,there was no statistically significant difference between the recanalization rate(97.1%vs.92.9%,P=0.341)and the symptomatic intracranial hemorrhage rate(4.3%vs.14.3%,P=0.104).Conclusion:1.Endovascular treatment of acute posterior circulation large vessel occlusive stroke is safe and effective.2.Lower NIHSS scores,higher BATMAN and Pc-ASPECTS scores and rapid vascular recanalization indicate better efficacy and safety,but factors such as stroke type,thrombus location,bridging thrombolysis,and anesthesia methods have no significant effect on clinical prognosis.3.For the endovascular treatment of large vessel occlusive stroke in the posterior circulation,the direct aspiration has similar efficacy and safety compared to the stent retriever,and can recanalize the blood vessel in a shorter time. |
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