中间导管辅助取栓技术在急性基底动脉闭塞血管内治疗中的应用

Application of intermediate catheter in the procedure of mechanical thrombectomy to treat acute basilar artery occlusion

目的探讨中间导管对急性基底动脉闭塞(acute basilar artery occlusion,ABAO)机械取栓的作用。方法回顾性分析150例连续入组的ABAO患者的临床、技术及功能结局资料。根据机械取栓术中是否使用中间导管分为2组:中间导管组(n=52),常规取栓组(n=98)。对比分析2组患者取栓次数、血管开通情况、术中并发症等相关指标。血管成功再通定义为改良脑梗死溶栓(mTICI)治疗后血流分级2b/3级。采用改良Rankin量表(mRS)评分评定术后3个月临床预后,0~3分为预后良好。结果 2组90 d良好预后率分别为:中间导管组50.00%(26/52),常规取栓组44.90%(60/98);血管再通率分别为:中间导管组98.08%(51/52),常规取栓组98.98%(97/98);中间导管组穿刺至血管再通时间中位数为77.0(64.25,77.00) min,明显短于常规取栓组92.5(63.00,132.50) min(P<0.05);前者取栓次数中位数1.0(1.0,2.0)明显小于后者2.0(1.0, 3.0)(P<0.05);2组术中远端血管栓塞并发症情况比较差异无统计学意义(P>0.05)。结论急性基底动脉闭塞机械取栓术中应用中间导管辅助可降低靶血管穿刺至复流时间。

Objective To explore the effect of intermediate catheter on the procedure of mechanical thrombectomy in treatment of acute basilar artery occlusion(ABAO).Methods The clinical,technical and functional outcome data of 150 consecutive ABAO patients were retrospectively analyzed.According to whether an intermediate catheter was used during mechanical thrombectomy,they were divided into two groups:intermediate catheter group(n=52)and conventional thrombectomy group(n=98).The number of passes,rate of successful recanalization,rate of intraoperative complications and other related indicators between the two groups of patients were compared and analyzed.Successful recanalization of target vessels was defined as modified thrombolysis in cerebral infarction(mTICI)score 2b/3.The modified Rankin Scale(mRS)was used to evaluate the clinical prognosis at 3 months after the operation,with a score of 0 to 3 as good prognosis.Results The good prognosis rates at 90days after operation of the two groups were:50.00%(26/52)in the intermediate catheter group and 44.90%(60/98)in the conventional thrombus removal group.The difference was not statistically significant(P>0.05);the recanalization rates were respectively:98.08%(51/52)in the intermediate catheter group,98.98%(97/98)in the conventional thrombectomy group,the difference was not statistically significant(P>0.05);the median time from puncture to recanalization of the intermediate catheter group was 77.0(64.25,77.00)min,significantly shorter than 92.5(63.00,132.50)min in the conventional thrombectomy group(P<0.05);the number of passes of the former was significantly less than the latter 2.0(1.0,3.0),with a median of 1.0(1.0,2.0)(P<0.05);There was no significant difference in the complications of distal vascular embolism between the two groups(P>0.05).Conclusion The application of intermediate catheter reduces the length of mechanical thrombectomy procedure in treating ABAO.