Application of modified SWIM technique in mechanical thrombectomy of acute ischemic stroke

Abstract

Objective To investigate the efficacy and safety of modified SWIM technique formechanical thrombectomy in patients with acute ischemic stroke. Methods Total 114 patients with acuteischemic stroke who underwent mechanical thrombectomy in The Third the People's Hospital of Bengbufrom January 2021 to January 2024 were included. Modified SWIM technique (modified thrombectomygroup, n = 57) and conventional SWIM technique (conventional thrombectomy group, n = 57) were givenrespectively. Vascular recanalization rate of the first thrombectomy, overall vascular recanalization rate, thenumber of thrombectomy, puncture⁃to⁃reperfusion time, near⁃term neurological deficits [National Institutes of Health Stroke Scale (NIHSS) at 14 d postoperatively] and long⁃term neurological prognosis [modified RankinScale (mRS) at 90 d postoperatively] were recorded, as well as symptomatic intracranial hemorrhage (sICH)rate and mortality. Results The vascular recanalization rate of the first thrombectomy in modifiedthrombectomy group was higher than that in conventional thrombectomy group (χ2 = 5.054, P = 0.025), thenumber of thrombectomy was less than (Z = 2.014, P = 0.044), and puncture⁃to⁃reperfusion time was shorterthan (Z = 2.630, P = 0.009) conventional thrombectomy group. There was a statistically significant differencein NIHSS score between modified thrombectomy group and conventional thrombectomy group before andafter surgery (F = 5.185, P = 0.025), and there was also a statistically significant difference in NIHSS scorebetween the 2 groups at admission and 14 d after surgery (F = 133.705, P = 0.000). There was not aninteraction between treatment factors and measurement times (F = 3.148, P = 0.079). The NIHSS score 14 dafter surgery in modified thrombectomy group was lower than that in conventional thrombectomy group (t =2.969, P = 0.004). The NIHSS score of modified thrombectomy group (t = 10.286, P = 0.000) andconventional thrombectomy group (t = 6.428, P = 0.000) were lower at 14 d after surgery than those atadmission. There was a statistically significant difference in mRS score between modified thrombectomygroup and conventional thrombectomy group before and after surgery (F = 7.581, P = 0.007), and there wasalso a statistically significant difference in mRS score between the 2 groups at admission and 90 d aftersurgery (F = 277.328, P = 0.000). There was an interaction between treatment factors and measurementtimes (F = 10.471, P = 0.002), and the effect of modified SWIM technique was better. Modifiedthrombectomy group had a better prognosis (mRS score ≤ 2) at 90 d after surgery than conventionalthrombectomy group (χ2 = 4.267, P = 0.039). There were no significant differences in the incidence ofpostoperative sICH rate (χ2 = 0.077, P = 0.782) and the mortality (χ2 = 0.101, P = 0.751) between 2 groups. Conclusions The application of modified SWIM technique in mechanical thrombectomy has better efficacyand safety than conventional SWIM technique, and is worthy of clinical promotion.

doi：10.3969/j.issn.1672⁃6731.2024.11.004