支架联合中间导管接触性抽吸技术在急性大脑中动脉闭塞机械取栓中的应用  

Application of intermediate catheter contact suction combined stent-retriever mechanical thrombectomy technique in the treatment of acute middle cerebral artery occlusion

作　　者：杜世伟[1] 李桂林[1] 高鹏[1] 李静伟[1] 尚峰 陈健[1] 张鸿祺[1] 吉训明[1] Du Shiwei;Li Guilin;Gao Peng;Li Jingwei;Shang Feng;Chen Jian;Zhang Hongqi;Ji Xunming(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科

出　　处：《中国脑血管病杂志》2019年第7期362-367,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨支架联合中间导管接触性抽吸技术在急性大脑中动脉闭塞开通中应用的安全性和有效性。方法回顾性分析2018年3月至6月于首都医科大学宣武医院神经外科接受支架联合中间导管接触性抽吸机械取栓治疗的急性大脑中动脉闭塞患者15例的病例资料,记录患者年龄、性别、入院美国国立卫生研究院卒中量表(NIHSS)评分、Alberta卒中项目早期CT评分(ASPECT)评分、血管再通分级[改良脑梗死溶栓试验(mTICI),mTICI分级≥2b为血管成功再通]、一次再通率、股动脉穿刺至成功再通时间、手术相关并发症、出院NIHSS评分以及患者术后90d改良Rankin量表(mRS)评分(mRS评分0~2为预后良好)。通过SPSS23.0软件对组间相关数据差异进行分析。结果15例中,男12例,女3例;年龄36~74岁,平均(57±12)岁,合并高血压病12例,糖尿病4例,高脂血症12例,心房颤动6例,卒中史2例,吸烟史8例;ASPECT评分6~10分,平均(8.5±1.4)分;入院NIHSS评分7~16分,平均(12.0±2.9)分。15例患者均实现闭塞大动脉再通成功,自股动脉穿刺至成功再通时间20~120min,中位时间43.6(31.3,47.2)min,一次实现血管再通成功12例(12/15),无严重的操作相关并发症。患者出院时NIHSS评分0~12分,中位评分3.4(2.7,3.8)分。术后90d随访,患者预后良好12例。结论中间导管接触性抽吸结合支架取栓技术治疗急性大脑中动脉闭塞是一种安全有效的血管内机械取栓方法。Objective To investigate the safety and efficacy of intermediate catheter contact suction combined stent-retriever mechanical thrombectomy technique in the treatment of acute middle cerebral artery (MCA) occlusion. Methods All 15 patients with acute MCA occlusion and underwent intermediate catheter contact suction combined stent retriever mechanical thrombectomy were retrospectively analyzed.Recorded data were the followings:age,gender,National Institute of Health stroke scale(NIHSS)score at admission,Alberta Stroke Program Early CT Score (ASPECTS),recanalization grade [successful revascularization:modified Thrombolysis in Cerebral Infarction (mTICI)≥2b],successful first-pass reperfusion rate,groin puncture-to-recanalization time,complications,NIHSS score at discharge,and clinical outcome at 90 d follow -up (good outcome:modified Rankin scale[mRS]score 0 - 2).Software SPSS 23.0 was used for data analysis between groups. Results Among 15 patients,12 were men and 3 were women.The age ranged from 36 years to 74 years with the mean of 57±12 years.12 patients had hypertensions,4 had diabetes, 12 had hyperlipidemia,6 had arterial fibrillation,2 had a history of stroke,and 8 had a history of smoking.The mean ASPECT score (range) was 8.5±1.4 (6 - 10) and the mean NIHSS score (range) at admission was 12.0±2.9 (7 - 16).All 15 patients achieved large vessel successful recanalization (mTICI ≥2b).Groin puncture-to-recanalization time ranged from 20 to 120 min and the median was 43.6 (31.3,47.2) min. 12(12 /15) cases achieved successful first-pass recanalization.No severe procedure-related complications occurred .NIHSS score at discharge ranged from 0 to 12 with the median 3.4 (2.7,3.8).Clinical outcome evaluation at 90 d follow-up showed 12 patients had good outcome. Conclusion The technique of intermediate catheter contact suction combined stent-retriever mechanical thrombectomy is a safe and effective endovascular treatment of acute middle cerebral artery occlusion.

关 键 词：支架 抽吸导管 大脑中动脉闭塞 机械取栓 

分 类 号：R651.1[医药卫生—外科学]