ADAPT技术在急性脑动脉闭塞血管内再通治疗中的应用  

Endovascular recanalization with a direct aspiration first-pass thrombectomy technique for acute cerebral artery occlusion

作　　者：张合亮[1] 郭再玉[1] 刘美利[1] 侯延伟 赵卫华[1] 赵伟[1] 李博[1] 田思思[1] Zhang Heliang Guo Zaiyu Liu Meili Hou Yanwei Zhao Weihua Zhao Wei Li Bo Tian Sisi(Department of Neurosurgery, TEDA Hospital, Tianjin 300457, Chin)

机构地区：[1]天津市泰达医院神经外科,300457

出　　处：《中华神经科杂志》2017年第6期445-451,共7页Chinese Journal of Neurology

基　　金：天津市卫生局科技基金资助项目（2012KZ047）;天津市滨海新区卫生局科技项目（2012BWKY027）;天津市卫生行业重点攻关项目（14KG134）

摘　　要：目的探讨ADAPT（a direct aspiration first－pass thrombectomy）技术治疗急性大血管闭塞性脑梗死的可行性、安全性和技术优势。方法回顾性分析2013年1月至2016年8月在我院行血管内再通治疗的急性脑梗死患者的临床资料，对比分析支架取栓和ADAPT技术治疗的患者的病例特点、术中情况、手术并发症和临床结果，并对ADAPT血管内再通方法的技术优势进行深入分析。结果观察期间，我院共对91例急性脑梗死患者实施了血管内机械再通手术，其中46例首选ADAPT技术，38例（82.6%）成功实施（ADAPT组）；21例应用了常规支架取栓技术（常规支架组），两组患者的基本病例特点和影像学特征差异无统计学意义（均P〉0.05）。尽管两组患者90 d神经功能恢复良好率[改良Rankin量表（mRS）评分≤2分]对比差异无统计学意义[61%（23/38）与48%（10/21），P＝0.247]，但ADAPT组患者术后7 d NIHSS评分[6.0（2.0，9.3）分与9.0（5.5，18.5）分，Z＝－2.031，P＝0.021]和术后90 d神经功能完全康复率（mRS＝0分）明显优于常规支架组[37%（14/38）与10%（2/21），P＝0.022]；两组血栓逃逸率[21%（8/38）与29%（6/21），P＝0.365]、有效再通率[脑梗死溶栓治疗分级（TICI）2b/3级，84%（32/38）与81%（17/21），P＝0.507]和症状性脑出血发生率[0%（0/38）与9.5%（2/21），P＝0.123]，尽管差异不具统计学意义，但在数值上ADAPT组具有优势。结论ADAPT技术是一种安全、有效的血管内再通方法，与传统支架取栓技术相比，在患者术后NIHSS评分和远期神经功能完全康复率方面表现出了一定的优势，是值得进一步探索的一种血管内机械再通方法。ObjectiveTo investigate the feasibility, safety and technical superiority of mechanical thrombectomy using a direct aspiration first-pass thrombectomy （ADAPT） in treatment of patients with acute cerebral artery occlusion.MethodsA retrospective study was conducted on all patients with acute ischemic stroke treated with mechanical thrombectomy in our institution from January 2013 to August 2016. Patients using ADAPT or stent retriever as a first-line endovascular procedure were compared for clinical characteristics, procedural variables and clinical outcomes. The technical superiority of ADAPT was analyzed in depth.ResultsDuring observation period, a total of 91 cases were performed endovascular treatment with mechanical thrombectomy. ADAPT was designed in 46 cases as a first-line endovascular procedure and was utilized in 38 cases （82.6%; ADAPT group）, while primary stent retriever thrombectomy was performed in 21 patients（stent group）. There was no significant difference in baseline clinical or radiographic factors between ADAPT and stent groups. Although rates of good neurological outcome （modified Rankin Scale（mRS） score≤2） at 90 days were similar between the ADAPT and stent groups （61%（23/38） vs 48%（10/21）, P=0.247）, National Institute of Health Stroke Scale （NIHSS） score at seven days （6.0（2.0, 9.3） vs 9.0（5.5, 18.5）, Z=-2.031, P=0.021） and full recovery rate of neurological outcome （mRS score=0, 37%（14/38） vs 10%（2/21）, P=0.022） were significantly better in the ADAPT group than in the stent group. There were no significant differences in rates of embolus to new territory （21%（8/38） vs 29%（6/21）, P=0.365）, Thrombolysis In Cerebral Infarction （TICI） 2b/3 grade revascularization （84%（32/38） vs 81%（17/21）, P=0.507） and symptomatic intracerebral hemorrhage （0%（0/38） vs 10%（2/21）, P=0.123） between the ADAPT and the stent groups, but the figures were better in the ADAPT group.ConclusionsMechanical thrombectomy usin

关 键 词：脑梗塞 血栓切除术 抽吸 支架 

分 类 号：R651.12[医药卫生—外科学]