远端滤网保护伞在症状性颈内动脉闭塞血管内再通治疗中的应用

Application of distal filter protection for recanalization therapy in patients with symptomatic internal carotid artery occlusion

目的 观察远端滤网保护伞在症状性颈内动脉闭塞血管内再通治疗中的可行性和有效性.方法 回顾性分析2009年7月至2012年12月第二军医大学附属长海医院神经外科采用血管内再通治疗症状性颈内动脉闭塞术中应用远端滤网保护伞患者的临床及影像学资料.共纳入23例患者,末次事件至治疗的中位时间为30 d（范围为8-510 d）.结果 23例中,22例成功应用保护伞,1例因颈内动脉迂曲不能到达远端,技术成功率为96％.18例术后血流达到脑梗死溶栓分级（TICI）2 b-3级,其中13例（57％）达到完全再通（TICI 3级）,再通成功率为78％.2例回收的保护伞中可观察到粥样斑块碎屑.9例（39％）术后磁共振弥散成像显示多发点状梗死灶,1例发生颅内出血（出院时无神经功能缺损）.术后行头颅CT灌注成像的21例,均显示血流动力学较术前改善（P＜0.01或P＜0.05）.围手术期无一例发生症状性卒中及死亡.影像学随访（19.7±9.3）个月,临床随访（21.0±8.4）个月,1例术后4个月时出现支架内再狭窄,经过再次治疗后好转;其余患者在随访期间无症状性卒中或死亡发生.结论 术中使用远端保护伞辅助血管内治疗症状性颈内动脉闭塞是安全可行的,但其疗效尚需要长期随访和进一步临床验证.

Objective To investigate the safety and efficacy of distal filter protection for endovascular recanalization in patients with symptomatic internal carotid artery occlusion （ICAO） Methods Retrospective analysis was conducted in patients with symptomatic ICAO screened from the prospectively collected database who underwent endovascular recanalization with distal filters from July 2009 to December 2012.Clinical characteristics,procedural results and outcomes wcre investigated by reviewing medical records and angiographic data.Totally,twenty three patients were included with the median occlusion time of thirty days （range,8-510 days）.Results Totally in twenty three patients,technical success rate of 96% was obtained in twenty two patients.One filter failed to arrive in distal lumen due to the tortuosity of internal carotid artery.Successful recanalization （TICI 2b-3） was obtained in 18 patients （78%）,including 13 patients （57%） with complete （TICI 3） recanalization.Downstream thrombotic clots were observed in two retrieved filters.After procedure,dotted ischemic lesions were detected on MRI in 9（39%） patients and intracranial hemorrhage occurred in 1 patient without neurologic sequelae.No perioperative death or ischemic stroke occurred.At the radiological follow-up of 19.7 ± 9.3 months and clinical follow-up of 21.0 ± 8.4 months,instent restenosis occurred in one case four months after the procedure and in-stent stenting was performed without complications,and other patients remain uneventful.Conclusion Distal filter protection is safe and feasible for the procedure of endovascular recanalization of symptomatic ICAO.Further clinical investigation and long-term follow-up are warranted to validate its effectiveness.