直接抽吸取栓术与支架取栓术治疗急性大脑中动脉粥样硬化性闭塞的疗效对比研究  

Comparison of the clinical efficacy between direct aspiration thrombectomy and stentthrombectomy for acute atherosclerotic occlusion of middle cerebral artery

作　　者：程娅雯 韩香凝 李嘉豪 商苏杭 程三平 张润宁[2] 韩建峰[1] 刘福德 CHENG Yawen;HAN Xiangning;LI Jiahao;SHANG Suhang;CHENG Sanping;ZHANG Running;HAN Jianfeng;LIU Fude(Department of Neurology and Stroke Center,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061;The Second Department of Encephalopathy,The Second Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,China)

机构地区：[1]西安交通大学第一附属医院神经内科,陕西西安710061 [2]陕西中医药大学第二附属医院脑病二科,陕西咸阳712000

出　　处：《西安交通大学学报（医学版）》2024年第4期603-608,共6页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：陕西省自然科学基础研究计划项目(No.2023-JC-QN-0893);陕西省重点研发计划项目(No.2021SF-059)。

摘　　要：目的 比较首选直接抽吸技术(a direct aspiration first-pass technique, ADAPT)与支架取栓(stent-retriever thrombectomy, SRT)治疗急性大脑中动脉粥样硬化性闭塞(intracranial atherosclerotic stenosis related large vessel occlusion, ICAS-LVO)所致急性缺血性卒中(acute ischemic stroke, AIS)患者的临床疗效。方法 回顾性连续纳入2020年1月至2023年1月西安交通大学第一附属医院神经内科及陕西省中医药大学第二附属医院脑病二科接受血管内治疗的急性大脑中动脉ICAS-LVO所致AIS患者,根据首选取栓装置将患者分为ADAPT组和SRT组,比较两组患者的基线资料、检验及检查结果、手术过程及临床预后等。结果 共纳入117例患者,其中ADAPT组48例,SRT组69例,两组患者的基线资料无统计学差异。SRT组首次取栓成功再通率(P=0.014)及首选取栓装置成功再通率(P<0.001)均高于ADAPT组,且医源性夹层(P<0.001)及血管痉挛(P=0.003)的发生率显著降低;而ADAPT组更换取栓装置补救治疗比例显著高于SRT组(P<0.001);但在最终血管成功再通率、症状性及无症状性颅内出血发生率和90 d良好预后率等方面,两组无统计学差异。结论 对于急性大脑中动脉ICAS-LVO患者,首选SRT治疗相较于ADAPT治疗具有更高的即刻成功再通率,且血管损伤风险更小,但二者改善患者预后的作用相似。Objective To compare the clinical efficacy between a direct aspiration first-pass technique(ADAPT)and stent-retriever thrombectomy(SRT)in the treatment for acute ischemic stroke(AIS)caused by intracranial atherosclerotic stenosis related large vessel occlusion(ICAS-LVO).Methods We retrospectively included patients with AIS caused by ICAS-LVO who received endovascular treatment in The First Affiliated Hospital of Xi’an Jiaotong University or The Second Affiliated Hospital of Shaanxi University of Chinese Medicine between January 2020 and January 2023.They were divided into ADAPT group and SRT group according to the first-selected device for thrombectomy.We compared the baseline data,test and examination results,operation process,clinical prognosis and follow-up data of the two groups.Results A total of 117 patients were recruited,including 48 patients in the ADAPT group and 69 patients in the SRT group.There was no significant difference in the baseline data between the two groups.The success rate of both the first-time thrombectomy(P=0.014)and the first-selected device of thrombectomy(P<0.001)was significantly higher in the SRT group than in the ADAPT group.Meanwhile,the incidence of iatrogenic dissection(P<0.001)and vasospasm(P=0.003)was significantly lower in the SRT group than in the ADAPT group.The proportion of patients for whom the device of thrombectomy was changed for remedial treatment in the ADAPT group was significantly higher than that in the SRT group(P<0.001).However,the two groups did not differ significantly in the rate of successful vascular recanalization,incidence of symptomatic/asymptomatic intracranial hemorrhage or the rate of 90-day favorable prognosis.Conclusion For patients with AIS caused by ICAS-LVO of MCA,SRT has a higher rate of immediate successful vascular recanalization with a lower rate of secondary vascular injury compared with ADAPT,but the two techniques have similar efficacy on the 90-day prognosis.

关 键 词：首选直接抽吸技术(ADAPT) 支架取栓(SRT) 动脉粥样硬化 大血管闭塞 急性缺血性卒中 

分 类 号：R743[医药卫生—神经病学与精神病学]