比较2种微导丝对脑卒中支架取栓速度及安全性的影响

Comparison of impacts on efficiency and safety between two types of microwires during mechanical thrombectomy for stroke

目的·比较0.014 in的Synchro微导丝和Transend微导丝对急性缺血性脑卒中支架取栓的速度及安全性的影响。方法·入组2012年10月至2017年1月在上海交通大学医学院附属第九人民医院接受机械取栓的急性缺血性卒中患者46例,分为Synchro组(21例)和Transend组(25例),比较2组手术操作时间及安全性等指标。结果·2组闭塞血管再通率类似(P=0.600),但Synchro组从股动脉穿刺至血管再通时间显著短于Transend组(48.88 min vs 82.33 min,P=0.001)。2组患者术后3个月获得功能独立(mRS≤2)的比例类似(P=1.000),操作后蛛网膜下腔出血发生率类似(P=1.000)。但Transend组有2例因血管穿孔导致严重蛛网膜下腔出血伴血肿,均死亡;Synchro组仅有1例轻微的单纯蛛网膜下腔出血,恢复良好。结论·和Transend微导丝相比,Synchro微导丝能够缩短支架取栓操作时间,致命性蛛网膜下腔出血风险较小。

Objective · To compare the impacts on clinical efficiency and safety between 0.014 inch Synchro microwire and Transend microwire used during mechanical thrombectomy for acute ischemic stroke （AIS） caused by large artery occlusion. Methods · Forty-six patients undergoing mechanical thrombectomy with stent retrievers between October 2012 and January 2016 were included, who were classified into Synchro group （21 cases） and Transend group （25 cases）. The clinical outcome, procedure time, and safety were analyzed and compared between two groups. Results · The recanalization rates were similar between two groups （P=0.600） , but time from puncture to vascular recanalization of Synchro group was much shorter than that of Transend goup （48.88 min vs 82.33 min, P=0.001）. The rates of functional independence （modified Rankin scale score ≤ 2） were similar between two groups （P=1.000）. There was no significant difference of the rates of post-procedure subarachnoid hemorrhage （PSAH） between two groups （P=1.000）. However, there were two cases that had fatal subarachnoid hemorrhage with intracranial hematoma in Transend group, while there was only one case of mild subarachnoid hemorrhage who recovered well in Synchro group. Conclusion · Compared with Transend microwire, Synchro microwire can significantly shorten the procedure time of mechanical thrombectomy, and the risk of fatal subarachnoid hemorrhage is rather small.