球囊导引导管近端血流控制技术在机械取栓治疗急性前循环大动脉闭塞性脑梗死中的作用

Role of balloon guided catheter proximal flow control technique in mechanical thrombectomy for acute ischemic stroke with anterior circulation large artery occlusion

目的探讨球囊导引导管(BGC)近端血流控制技术在机械取栓治疗急性前循环大动脉闭塞性脑梗死中的作用。方法纳入2018年1月至2019年12月郑州大学人民医院脑血管病科(33例)、南阳市中心医院神经科(18例)及郑州大学附属郑州中心医院介入科(11例)采用机械取栓术治疗的急性前循环大动脉闭塞性脑梗死患者,共62例,术中均采用BGC近端血流控制技术。其中颈内动脉合并大脑中动脉闭塞者36例,大脑中动脉水平段闭塞者26例。回顾性观察手术时间、血管的再通情况[采用脑梗死溶栓(TICI)分级标准评估]、手术相关并发症及术后90 d的改良Rankin量表评分(mRS)。结果62例患者的中位手术时间为94.0 min(P25和P75分别为53.0、129.3 min)。其中57例(91.9%)血管再通成功(TICI分级为2b~3级),5例(8.1%)失败。取栓次数≤2次者占65.8%(47/62),其中35.5%(22/62)1次取栓成功。51.6%(32/62)患者取栓术后置入支架。62例患者中,17例(27.4%)出现并发症,其中术中发生血栓栓塞事件7例(11.3%),术后出现症状性脑出血10例(16.1%);死亡8例(12.9%)。62例患者术后90 d内预后良好(mRS≤2分)者37例(59.7%),预后不良(mRS≥3分)者25例(40.3%)。结论机械取栓治疗急性前循环大动脉闭塞性脑梗死术中采用BGC近端血流控制技术手术时间短,血管再通率和首次血管再通率较高,血栓栓塞事件发生率较低,术后90 d预后良好比率高。

Objective To investigate the role of balloon guided catheter(BGC)proximal blood flow control technique in mechanical thrombectomy for acute ischemic stroke with anterior circulation large artery occlusion.Methods Sixty-two patients with acute ischemic stroke with anterior circulation large artery occlusion who underwent mechanical thrombectomy from January 2018 to December 2019 at Department of Cerebrovascular Diseases,Zhengzhou University People′s Hospital,Department of Neurological Diseases,Nanyang Central Hospital and Department of Neurological Disease,Zhengzhou Central Hospital Affiliated to Zhengzhou University were enrolled into this study.BGC proximal blood flow control technique was used during operation of all cases.Among them,there were 36 cases of internal carotid occlusion combined with middle cerebral artery occlusion and 26 cases of middle cerebral artery occlusion in the horizontal segment.Duration of operation,recanalization of blood vessels[based on thrombolysis in cerebral infarction(TICI)score],surgical complications,and modified Rankin scale(mRS)at 90 days post operation were retrospectively analyzed.Results The median duration of operation of 62 patients was 94.0 min(P25:53.0 min,P75:129.3 min).Successful recanalization(TICI 2b~3 grade)was achieved in 57 cases(91.9%)and failure was reported in 5 cases(8.1%).There were 47 cases(65.8%)with thrombus removal≤2 times,of which 22 cases(35.5%)were successful in 1 thrombus removal.Thirty-two patients(51.6%)underwent stenting after embolization.Complications occurred in 17 cases(27.4%),including 7 cases(11.3%)of intraoperative thromboembolic events and 10 cases(16.1%)of symptomatic cerebral hemorrhage after operation,and 8 cases(12.9%)died.Among 62 cases,37(59.7%)had a good outcome(≤2 score)within 90 days after surgery,and 25 cases(40.3%)had a poor outcome.Conclusion Mechanical thrombectomy in the treatment of acute anterior circulation large artery occlusive cerebral infarction using BGC proximal blood flow control technology seems to be associated with short operative duration,high rates of blood vessel recanalization and that post single procedure,low incidence of thromboembolic events,and the proportion of good outcomes at 90 d post operation.