SOFIA远端通路导管直接血栓抽吸和支架取栓治疗早期急性缺血性脑卒中疗效比较  

Safety and efficacy of SOFIA distal access catheter aspiration thrombectomy in the treatment of early acute ischemic stroke

作　　者：马浩源 赵岩 胡明[3] 孙强 杨乔 马良 徐国栋[3] 董艳红[3] 吕佩源[3] MA Haoyuan;ZHAO Yan;HU Ming;SUN Qiang;YANG Qiao;MA Liang;XU Guodong;DONG Yanhong;LV Peiyuan(Hebei General Hospital,Shijiazhuang 050000,China)

机构地区：[1]华北理工大学研究生学院现河北省人民医院神经内科,石家庄050000 [2]河北医科大学研究生学院 [3]河北省人民医院神经内科

出　　处：《中国神经精神疾病杂志》2020年第4期216-220,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：2014年河北省政府资助临床医学优秀人才培养项目(编号:361003);2015年河北省政府资助临床医学优秀人才培养和基础课题研究项目(编号:81241037);河北省卫生厅科研基金项目青年科技课题(编号:20160459);河北省高端人才资助项目(编号:6833452)。

摘　　要：目的评估SOFIA远端通路导管直接抽吸治疗早期急性缺血性脑卒中(acute ischemic stroke,AIS)的安全性及有效性。方法选取2018年1月至2019年10月间进行血管内治疗的早期AIS患者65例,其中20例首选SOFIA远端通路导管抽吸取栓治疗(抽吸组),45例首选支架取栓治疗(支架组)。采用改良脑梗死溶栓治疗分级(modified treatment in cerebral ischemia,mTICI)、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)、改良Rankin量表评分(modified rankin scale,mRS)分别评估成功再通及临床预后。对比抽吸组与支架组的手术相关指标(手术时间、血管成功再通)、并发症及临床预后。结果抽吸组较支架组穿刺至血管成功再通时间短,差异具有统计学意义[27(14,36)min vs.34(29,50)min,P<0.05],而血管成功再通率(mTICI 2b/3级)差异无统计学意义(18/20 vs.38/45,P>0.05)。抽吸组与支架组发生血栓逃逸(1/20 vs.3/45)、颅内出血(3/20 vs.7/45)和其他不良事件(1/20 vs.5/45),差异无统计学意义(P>0.05)。抽吸组与支架组术后24 h和7 d NIHSS评分[10(5,13)vs.12(7,17),5(3,11)vs.10(3,15)],90 d mRS评分≤2分及死亡率,差异均无统计学意义(P>0.05)。结论与首选支架取栓相比,SOFIA远端通路导管直接抽吸治疗早期AIS患者具有相似安全性及疗效,且具有操作简单用时短的特点。Objective To evaluate the safety and efficacy of first aspiration of SOFIA distal access catheter aspiration thrombectomy in the treatment of early acute ischemic stroke(AIS).Methods Sixty five patients with early AIS from January 2018 to October 2019 were selected,of which 20 patients were treated with the SOFIA distal access catheter aspiration thrombectomy(aspiration group)and 45 patients were treated with stent thrombectomy(sent group).Successful recanalization and clinical prognosis were assessed by modified treatment in cerebral infarction(mTICI),National Institute of Health stroke scale(NIHSS),and modified Rankin scale(mRS).Surgical indicators(operative time,successful recanalization),complications and clinical prognosis were compared between the aspiration group and the sent group.Results Compared with the sent group,the time from puncture to successful recanalization in the aspiration group was shorter[27(14,36)min vs.34(29,50)min,P<0.05].However,the successful recanalization(mTICI 2b/3)was no statistical significance(18/20 vs.38/45,P>0.05).In the aspiration group and the sent group,the embolus to new territory(1/20 vs.3/45),intracranial hemorrhage(3/20 vs.7/45)and other adverse events(1/20 vs.5/45)was no statistical significance(P>0.05).NIHSS score at 24 hours and 7 days after the operation[10(5,13)vs.12(7,17),5(3,11)vs.10(3,15)],mRS≤2 at 90 days and death were slightly lower in the aspiration group compared with sent group,but difference was not significant(P>0.05).Conclusion Compared with the first choice of stent thrombectomy,SOFIA distal access catheter direct aspiration treatment for early AIS patients is much simpler and faster with similar safety and efficacy.

关 键 词：急性缺血性脑卒中 SOFIA 抽吸 

分 类 号：R743.3[医药卫生—神经病学与精神病学]