恢复灌注-球囊扩张-机械取栓-支架成形技术在颈动脉串联病变中的应用

Application of reperfusion-expanding-thrombectomy-stenting technique in carotid tandem lesions

目的探讨恢复灌注-球囊扩张-机械取栓-支架成形(RETS)技术在急性颈动脉串联病变血管内治疗的可行性及临床疗效。方法回顾性分析2018年1月至2020年12月于临沂市人民医院神经内科行急诊血管内治疗的颈动脉串联病变患者的临床资料,以改良Rankin量表(mRS)评分作为标准评价患者90 d随访时预后情况,并对不同开通方式患者的临床资料进行分析,包括术后血管成功再通(改良脑梗死溶栓血流分级≥2b级)率、围手术期并发症、90 d良好预后(mRS评分≤2分)率等。结果共纳入88例颈动脉串联病变患者,其中采用RETS技术治疗者48例,采用顺向开通40例。与顺向开通组[(98.88±26.09)min]相比,采用RETS技术组穿刺至再通时间更短[(72.06±17.29)min,t=-5.56,P<0.001],远端一次取栓再通率更高[35/48(73.0%)比21/40(52.5%),χ^(2)=3.93,P=0.047],差异有统计学意义;两组在患者临床预后及手术并发症方面差异无统计学意义(均P>0.05)。结论RETS技术能缩短手术时间,提高远端一次取栓再通率,用以治疗颈动脉串联病变安全可行。

Objective To analyze the feasibility and clinical efficacy of reperfusion-expanding-thrombectomy-stenting(RETS)technique in the endovascular treatment of acute carotid artery tandem lesion.Methods The general clinical data of 88 patients with carotid artery tandem lesion who received emergency endovascular treatment from January 2018 to December 2020 in Department of Neurology,Linyi People′s Hospital were reviewed,the Modified Rankin Scale(mRS)was used as the evaluation standard for the prognosis of patients at 90 days after endovascular treatment,and the clinical data were analyzed,including the recanalization(modified thrombolysis in cerebral infarction≥2b),perioperative complications and 90-day prognosis,and good prognosis was defined as a mRS score of 0-2.Results A total of 88 patients with tandem carotid artery disease were included,48 of whom were treated with RETS technique,40 were treated with anterograde approach.Compared with antegrade recanalization,RETS technique had significant differences in the time from puncture to recanalization[(72.06±17.29)min vs(98.88±26.09)min,t=-5.56,P<0.001]and the primary recanalization rate[35/48(73.0%)vs 21/40(52.5%),χ^(2)=3.93,P=0.047],with statistically significant difference.There was no significant difference in clinical prognosis and surgical complications between the two methods(all P>0.05).Conclusions RETS technique can shorten the operation time and increase the primary recanalization rate.RETS technique is safe and feasible for the treatment of carotid tandem lesions.