Sofia远端通路导管在急性前循环动脉闭塞取栓治疗中的初步应用  

Exploring the initial experience of the Sofia in the treatment of anterior circulation acute ischemic stroke

作　　者：韩宗利[1] 杜艳丽[2] 万仁宽 苏海波[1] 齐辉[1] Han Zongli;Du Yanli;Wan Renkuan;Su Haibo;Qi Hui(Department of Neurosurgery,Peking University Shenzhen Hospital,Shenzhen 518036,China)

机构地区：[1]北京大学深圳医院神经外科,518036 [2]深圳职业技术学院医护学院

出　　处：《中国脑血管病杂志》2019年第7期368-372,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：深圳市卫生计生系统科研项目(201601005)

摘　　要：目的探讨应用6FSofia取栓装置治疗颅内动脉闭塞所致前循环急性缺血性卒中的效果。方法回顾性连续纳入2018年7月至12月北京大学深圳医院神经外科接受Sofia导管取栓(或)联合支架治疗的急性前循环动脉闭塞患者14例,其中单纯抽吸取栓患者10例,抽吸联合支架取栓患者4例。分析14例患者的临床特征、影像学资料及术后1周美国国立卫生研究院卒中量表(NIHSS)评分。以抽吸导管目标血管到位、闭塞血管再通及术后1周NIHSS评分及抽吸导管相关并发症为目标评估治疗的有效性。采用改良脑梗死溶栓试验(mTICI)标准评估血管开通程度(mTICI0~2a级为闭塞血管未开通,2b^3级为成功再通)。结果所有病例中抽吸导管均能顺利到达病变目标血管,闭塞血管总有效开通占比为13/14。10例单纯抽吸患者闭塞血管均成功开通,其中mTICI2b级2例,mTICI3级8例;4例抽吸联合支架取栓患者中,3例闭塞血管成功开通,其中mTICI2b级1例,mTICI3级2例。单纯抽吸和抽吸联合支架取栓的平均股动脉穿刺至血管开通时间分别为(34±10)min和(57±9)min。术后2例患者因大面积脑梗死死亡,其余12例患者术后1周NIHSS评分平均为(4.6±2.3)分,较术前明显下降[(15.5±6.1)分;Z=-3.061,P=0.002]。除1例发生血栓远端移位外,其余患者均未发生抽吸导管相关并发症。结论6FSofia抽吸导管有很好的血管通过性,使用6FSofia抽吸取栓术后1周效果较好,但其有效性、安全性尚需更大样本的对照研究以进一步证实。Objective To explore initial experience with 6-French Sofia for endovascular treatment of patients with anterior circulation acute ischemic stroke due to intracranial artery occlusion. Methods From July to December in 2018,14 consecutive patients with acute anterior circulation artery occlusion and underwent Sofia catheter thrombectomy and/or combined with stent in the Department of Neurosurgery, Shenzhen Hospital Peking University were retrospectively recruited.Ten patients had simple aspiration and 4 pat ients had aspiration combined with stent-retriever thrombectomy.The clinical characteristics,imaging data and postoperative National Institute of Health stroke scale(NIHSS) score at 1 week in all 14 patients were analyzed.The treatment effectiveness was evaluated by the accessibility to targeted lesion with catheter,the recanalization success rate,postoperative NIHSS score at 1 week and catheter-related complications.Grade of modified thrombolytic in cerebral Infarction (mTICI) was used to evaluate the recanalization (unsuccessful recanalization,mTICI 0 - 2a;successful recanalization,mTICI 2b - 3). Results In all 14 patients,the catheter could be advanced to the occlusion site.After mechanical thrombectomy,the total successful recanalization (mTICI≥2b) rate was 13/14.Ten patients underwent simple aspiration,with 2 cases achieved mTICI 2b and 8 cases achieved mTICI 3. The remaining 4 patients underwent aspiration combined with stent-retriever thrombectomy,and 3 patients had successful recanalization,including 1 case of mTICI 2b and 2 cases of mTICI 3.The average groin puncture-to-recanalization time of simple aspiration and aspiration combined with stent-retriever thrombectomy is 34±10 min and 57±9 min,respectively.Two patients died due to massive cerebral infarction after operation.The other 12 patients had an average NIHSS score at 1 week of 4.6±2.3,which was significantly lower than that of the preoperative NIHSS score (15.5±6.1;Z =-3.061, P =0.002).There were no catheter-related complications except on

关 键 词：梗塞 大脑中动脉 血管内治疗 机械取栓 取栓装置 

分 类 号：R743.3[医药卫生—神经病学与精神病学]