Syphonet支架远端保护技术在慢性颅内外动脉长节段闭塞开通术中的初步应用  

Preliminary application of the Syphonet stent distal protection technique in recanalization of chronic long-segment occlusion of intracranial and extracranial artery

作　　者：陆文炬 张一林 高慧丽 李强[1] 贺迎坤 蔡栋阳 夏金超 周腾飞 薛绛宇 王子亮 李天晓 李钊硕 Lu Wenxuan;Zhang Yilin;Gao Huili;Li Qiang;He Yingkun;Cai Dongyang;Xia Jinchao;Zhou Tengfei;Xue Jiangyu;Wang Ziliang;Li Tianxiao;Li Zhaoshuo(Department of Cerebrovascular Disease,People's Hospital of Henan University(Henan Provincial People's Hospital),Zhengzhou 450003,China)

机构地区：[1]河南大学人民医院(河南省人民医院)脑血管病中心,郑州450003

出　　处：《中华神经外科杂志》2024年第4期385-390,共6页Chinese Journal of Neurosurgery

基　　金：河南省医学科技攻关项目(SBGJ202102036);河南省科技攻关项目(232102521024)。

摘　　要：目的初步观察Syphonet支架在慢性颅内外长节段动脉闭塞(CIEAO)再通术远端保护中的作用。方法回顾性分析2022年11月至2023年4月在河南省人民医院脑血管病中心行CIEA0再通术的9例患者的临床资料。所有患者术中均采用Syphonet支架作为远端保护装置;改良脑梗死溶栓分级(mTICI)≥2b级为血管再通成功。观察手术情况及手术相关的并发症。术后6个月行头颅影像学检查评估血管再通情况;采用改良Rankin量表评分(mRS)评估患者的临床预后。结果9例患者均成功开通闭塞段血管。中位支架置入数量为2个(1~4个),支架均贴壁良好,中位手术操作时长为176min(120~220min)。1例患者术中发生血栓逃逸,血栓进入Syphonet远端保护装置并成功取出;1例患者术后6h发生脑出血(可能为亚急性脑梗死后出血转化),无死亡病例。术后6个月随访,1例患者失访;影像学评估显示,2例患者发生支架内血管再闭塞,6例患者无支架内血管狭窄;mRS0分5例,1、2、3分各1例。结论初步观察显示,CIEAO再通术中应用Syphonet支架远端保护的技术成功率高,可以捕获逃逸血栓,减少血栓脱落引发的并发症。支架内再狭窄或闭塞情况有待于进一步研究。Objective To observe the effect of Syphonet stent on distal protection in recanalization of chronic intracranial and extracranial long-segmental artery occlusion(CIEAO).Methods The clinical data of 9 patients with CIEAO who underwent recanalization at the Department of Cerebrovascular Disease,Henan Provincial People's Hospital from November 2022 to April 2023 were retrospectively analyzed.The Syphonet stent was used as the distal protection device during the operation in all patients.Successful recanalization of vessels was defined as modified thrombolysis in cerebral infarction(mTICI)≥2b.The surgical procedure and surgery-related complications were documented.Cranial imaging examination was performed at 6 months after the operation to evaluate vascular recanalization;the modified Rankin Scale(mRS)was used to evaluate the outcomes of patients.Results All 9 patients achieved successful recanalization.The median number of stents placed was 2(1-4),all stents adhered to the vascular wall well,and the operation time was 176(120-220)minutes.During the perioperative period,1 patient had intraoperative thrombus escape,which entered the Syphonet distal protection device and was successfully retrieved.At 6 hours post operation,1 patient had cerebral hemorrhage(possibly hemorrhagic transformation after subacute cerebral infarction),and there was no death cases.At 6-month follow-up after the procedure,1 patient was lost to follow-up;imaging evaluation showed in-stent vessel reocclusion in 2 patients and no in-stent vessel stenosis in the remaining patient.The mRS score was O in 5 cases,1 in 1 case,2 in 1 case,and 3 in 1 case.Conclusions The application of Syphonet stent distal protection technique in recanalization of CIEAO has a high technical success rate,which can capture the escaped thrombus and reduces the complications caused by thrombus detachment.In-stent restenosis or occlusion needs further study.

关 键 词：动脉闭塞性疾病 血管内操作 治疗结果 Syphonet支架 

分 类 号：R651.1[医药卫生—外科学]