单纯中间导管抽吸取栓技术治疗急性大血管闭塞性卒中患者的效果观察

Application of the technique of simple middle catheter aspiration in patients with acute large vessel occlusive stroke

目的探讨单纯中间导管抽吸取栓技术在急性大血管闭塞性缺血性卒中患者中的应用效果。方法回顾性连续纳入2018年5月至2020年3月就诊于河北省承德医学院附属医院行抽吸取栓(抽吸组,19例)和支架取栓(支架组,31例)的急性前循环大血管闭塞性卒中患者。记录2组患者取栓次数、血管再通率、术前及出院时的美国国立卫生研究院卒中量表(NIHSS)评分及预后等,并进行组间比较。血管再通率采用改良脑梗死溶栓试验(mTICI)分级进行评估,mTICI 2b^3级定义为血管成功再通;临床预后采用术后90 d改良Rankin量表(mRS)评分进行评估(mRS评分≤2分为预后良好)。应用SPSS 21.0软件进行数据的统计分析。结果抽吸组与支架组的血管再通率分别为16/19和77.4%(24/31,P=0.560);平均穿刺至血管再通时间分别为(37±14)、(46±22)min(P=0.118);平均血管内操作次数分别为(1.7±0.9)、(1.9±0.9)次(P=0.571),取栓次数在心源性栓塞病因中分别为(1.3±0.4)、(1.7±0.6)次(P=0.139),在大动脉粥样硬化型病因中分别为(2.1±1.2)次和(2.3±0.7)次(P=0.684);术后90 d预后良好率分别为10/19、41.9%(13/31;P=0.461)。结论抽吸取栓技术治疗急性大血管闭塞性缺血性卒中安全有效,血管再通率和功能预后与支架组相似。

Objective To investigate the technical applicability of simple middle catheter aspiration in patients with acute large vessel occlusion(LVO)ischemic stroke.Methods From May 2018 to March 2020,The study retrospectively recruited patients with anterior circulation vascular occlusive stroke and treated in our hospital for aspiration thrombectomy(aspiration group,19 cases)and stent thrombectomy(stent group,31 cases).The times of endovascular operation,rate of revascularization,National Institute of Health Stroke Scale(NIHSS)score before intervention and at discharge,and clinical outcomes were recorded and compared between groups.The rate of revascularization was assessed by modified Thrombolysis in Cerebral Infarction(mTICI).The clinical outcomes were assessed by modified Rankin score(mRS)at 90 days after intervention(favorable prognosis:mRS score≤2).SPSS 21.0 software was used for statistical analysis of those data.Results The recanalization rate(mTICI 2b-3)in the aspiration group and the stent group was 16/19 and 77.4%(24/31),respectively(P=0.560).The mean time from puncture to recanalization was(37±14)min and(46±22)min,respectively(P=0.118).The mean number of endovascular operation was(1.7±0.9)and(1.9±0.9;P=0.571),the number of thrombolytic embolization was(1.3±0.4)and(1.7±0.6;P=0.139),and the number of atherosclerotic etiology was(2.1±1.2)and(2.3±0.7;P=0.684).The favorable prognosis ratio was 10/19 and 41.9%(13/31,P=0.461)respectively on day 90 after intervention.Conclusions For endovascular recanalization of acute large vessel occlusion ischemic stroke,the simple middle catheter aspiration technique is safe and effective.The results of vascular recanalization rate and functional prognosis in aspiration group are similar to those in stent group.