Solumbra技术在急性大动脉闭塞性脑梗死机械取栓中的初步应用观察  

Preliminary application of Solumbra technique in mechanical thrombectomy in patients with acute large cerebral artery occlusion stroke

作　　者：陈付文 刘金朝 康孝理[2] 赵玉铁[3] 杨思福[1] 李红伟[1] 史宏生 汪子文 CHEN Fuwen;LIU Jinchao;KANG Xiaoli;ZHAO Yutie;YANG Sifu;LI Hongwei;SHI Hongsheng;WANG Ziwen(Department o f Interventional Radiology,Pwyang Oilfield General Hospital,Puyang,Henan Province 457001,China)

机构地区：[1]濮阳市油田总医院介入科,河南457001 [2]濮阳市油田总医院神经内科,河南457001 [3]濮阳市油田总医院急诊科,河南457001

出　　处：《介入放射学杂志》2019年第6期515-520,共6页Journal of Interventional Radiology

摘　　要：目的探讨Solumbra技术在急性大动脉闭塞性脑梗死机械取栓治疗中应用的可行性、有效性、安全性和技术优势。方法回顾性分析2016年1月至2017年12月采用血管内机械取栓治疗的59例急性大动脉闭塞性脑梗死患者临床资料。其中接受中间导管联合支架取栓患者31例(Solumbra组),接受常规导引导管联合支架取栓患者28例(常规支架取栓组)。比较两组患者手术相关指标、并发症及临床结果,分析Solumbra技术优势。结果Solumbra组、常规支架取栓组患者间性别、年龄、术前美国国立卫生研究院卒中量表(NIHSS)评分、发病至动脉穿刺时间(OPT)、侧支循环评分差异均无统计学意义(P>0.05);颈内动脉(ICA)闭塞患者(12/31对2/28,χ^2=8.100,P=0.004)、伴心房颤动患者(15/31对6/28,χ^2=4.66,P=0.031)差异有显著统计学意义;血管最终成功再通达到改良脑梗死溶栓(m TICI)治疗后血流评分标准2b/3级比例分别为93.5%、85.7%,一次取栓再通率达mTICI评分标准2b/3级比例分别为45.2%、25%,差异均无统计学意义(P>0.05);取栓次数[2(1,2)对2(1.25,3),Z=-2.177,P=0.029]、二次栓塞率(23.8%对39.3%,χ^2=3.991,P=0.046)、穿刺至再灌注时间(PRT)[(81±31)min对(100±35)min,t=2.315,P=0.028]差异均有统计学意义;颅内出血发生率分别为19.4%、10.7%(P>0.05),90 d良好预后率[改良Rankin量表(mRS)评分≤2]分别为48.4%、46.4%(P>0.05)。Solumbra组、常规支架取栓组ICA闭塞患者血管最终再通率分别为83.3%、0%(χ^2=5.833,P=0.016);90 d良好预后率分别为41.6%、0%(P>0.05),但Solumbra组占优。结论Solumbra技术是一种治疗急性大动脉闭塞性脑梗死的安全有效方法,与传统支架取栓术相比取栓效率更高,推荐用于一些路径血管迂曲、血栓负荷量大的患者。Objective To investigate the feasibility,effectiveness,safety and technological superiority of Solumbra technique for mechanical thrombectomy in patients with acute large cerebral artery occlusion stroke.Methods The clinical data of a total of 59 patients with acute large cerebral artery occlusion stroke,who were treated with endovascular mechanical thrombectomy during the period from January 2016 to December 2017,were retrospectively analyzed.Of the 59 patients,31 received intermediate catheter combined with stent thrombectomy(Solumbra group)and 28 received conventional guide-catheter combined with stent thrombectomy(conventional stent thrombectomy group).The surgery-related indexes,complications and clinical results were compared between the two groups.The technological superiority of Solumbra technique was evaluated.Results No statistically significant differences in sex,age,NIHSS score,onset-to-puncture time(OPT)and collateral circulation score existed between the two groups(P>0.05),while statistically significant differences in the number of patients with internal carotid artery(ICA)occlusion(12/31 vs 2/28,χ^2=8.100,P=0.004)and the number of patients with atrial fibrillation(15/31 vs 6/28,χ^2=4.66,P=0.031)existed between the two groups.The proportions of patients who achieved successful revascularization that reached 2 b/3 grade of blood flow scoring standard after modified modified thrombolysis in cerebral infarction(mTICI)in the Solumbra group and in the conventional stent thrombectomy group were93.5%and 85.7%respectively,and the up-to-standard revascularization rates with single thrombectomy procedure in the Solumbra group and in the conventional stent thrombectomy group were 45.2%and 25%respectively,both differences were not statistically significant(both P>0.05).In the Solumbra group and the conventional stent thrombectomy group,the numbers of thrombectomy time were 2(1,2)and 2(1.25,3)respectively(Z=-2.177,P=0.029),the secondary embolization rates were 23.8%and 39.3%respectively(χ^2=3.991,P=0.046),th

关 键 词：Solumbra技术 急性大动脉闭塞性脑梗死 机械取栓 支架 抽吸 

分 类 号：R543.4[医药卫生—心血管疾病]