直接抽吸一次性取栓治疗心源性栓塞型急性基底动脉闭塞临床分析  

A direct aspiration first pass technique for cardiogenic embolism-type acute basilar artery occlusion:a clinical analys

作　　者：刘露 李雪静 翟其金 陈春 刘玉峰 王清 赵连东 LIU Lu;LI Xuejing;ZHAI Qijin;CHEN Chun;LIU Yufeng;WANG Qing;ZHAO Liandong(Department of Neurology,Affiliated Huai'an Hospital of Xuzhou Medical University,Huai'an,JiangsuProvince223002,China)

机构地区：[1]徐州医科大学附属淮安医院神经内科,江苏淮安223002

出　　处：《介入放射学杂志》2023年第4期366-370,共5页Journal of Interventional Radiology

基　　金：国家自然科学基金(82105004)。

摘　　要：目的 探讨直接抽吸一次性取栓技术(ADAPT)治疗心源性栓塞型急性基底动脉闭塞(ABAO)患者的安全性、有效性及预后影响因素。方法 回顾性分析2018年1月至2021年6月徐州医科大学附属淮安医院采用ReactTM68导管系统血管内直接抽吸取栓术治疗的22例心源性栓塞型ABAO患者临床基线资料及手术相关指标。观察术后不良反应发生情况,评价术后7 d美国国立卫生研究院卒中量表(NIHSS)评分、术后90 d改良Rankin量表(mRS)评分。根据90 d mRS评分将患者分为预后良好(mRS评分0~2分)和预后不良(mRS评分3~6分),比较两者间临床资料及手术相关指标差异。结果 19例患者成功再通血管(mTICI血流分级3级或2b级)。术后90 d预后良好8例,预后不良14例,预后良好率为36.4%,病死3例(13.6%)。预后良好与预后不良患者相比,基线NIHSS评分更低(Z=-2.911,P=0.004),发病至到院时间更短(Z=-2.458,P=0.014)、发病至血管再通时间更快(Z=-2.321,P=0.020);术后不良事件症状性颅内出血、血栓逃逸、对比剂滞留差异无统计学意义(均P>0.05),9例大面积脑梗死均为预后不良患者(P=0.006);未发生手术操作相关并发症。结论 ADAPT治疗心源性栓塞型ABAO具有较高的血管再通率,可获得安全有效的临床预后。基线NIHSS评分、发病至到院时间、发病至血管再通时间可能是影响心源性栓塞型ABAO患者ADAPT治疗预后的因素。Objective To explore the safety, efficacy of a direct aspiration first pass technique(ADAPT) for cardiogenic embolism-type acute basilar artery occlusion(ABAO), and to discuss the factors that influence the prognosis. Methods The clinical baseline data and surgery-related indicators of 22 patients with acute basilar ABAO, who were admitted to the Affiliated Huai'an Hospital of Xuzhou Medical University of China between January 2018 and June 2021 to receive endovascular direct aspiration thrombectomy by using ReactTM68(Medtronic, USA) thrombus aspiration catheter system, were retrospective analyzed. The postoperative adverse reactions were recorded. The postoperative 7-day NIHSS score and postoperative 90-day m RS score were evaluated. According to the postoperative 90-day mRS score, the patients were divided into good prognosis group(mRS score 0-2 points) and poor prognosis group(mRS score 3-6 points). The clinical baseline data and surgery-related indicators were compared between the two groups. Results Successful revascularization was achieved in 19 patients(mTICI of grade 2b or grade 3). Good postoperative 90-day prognosis was obtained in8 patients and poor postoperative 90-day prognosis was obtained in 14 patients with a good prognosis rate of36.4%. Three patients died, the mortality rate was 13.6%(3/22). Compared with the poor prognosis group,in the good prognosis group the baseline NIHSS score was lower(Z=-2.911, P=0.004), the time from disease onset to hospital visit was shorter(Z=-2.458, P=0.014), and the time from disease onset to vascular recanalization was much shorter(Z=-2.321, P=0.020). No statistically significant differences in the incidence of postoperative adverse events including symptomatic intracranial hemorrhage, thrombus escape and contrast agent retention existed between the two groups(all P>0.05). All the 9 patients who suffered from large area cerebral infarction had a poor prognosis(P=0.006). No operation-related complications occurred. Conclusion For cardiogenic embolism-type ABAO, ADAP

关 键 词：心源性栓塞 基底动脉闭塞 直接抽吸一次性取栓技术 预后 

分 类 号：R651.12[医药卫生—外科学]