远端通路导管在急性缺血性卒中的临床应用研究

Clinical application of distal access catheter on treatment of acute isch-emic stroke

目的探讨以直接抽吸技术作为首选取栓策略时,远端通路导管在急性缺血性卒中机械取栓治疗的有效性及安全性。方法回顾性分析2019年1-12月在百色市人民医院神经内科接受远端通路导管进行机械取栓的急性大血管闭塞患者的40例患者的临床资料。男性25例,女性15例,年龄31~88岁,平均年龄(63.56±11.63)岁。大脑中动脉M1段闭塞17例(42.5%),颈内动脉段闭塞13例(32.5%),基底动脉闭塞10例(25%)。分析机械取栓的再通率、并发症以及90 d预后。术后患者神经功能变化的评价采用美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS),血管再通情况分析采用改良脑梗死溶栓分级(modified Throm‐bolysis in Cerebral Infarction Score,mTICI),术后90 d患者预后评估采用生活质量评分量表(Modified Rankin Scale,mRS)。结果入院时中位NIHSS为16.5(12.00,22.25)分,出院时中位NIHSS为4(2,10)分,与术前比较差异有统计学意义(P<0.01)。达到mTICI分级≥2b的37例,血管再通率92.5%;其中23例(57.5%)使用单纯抽吸,19例(82.61%)实现一次血管再通。90 d良好预后(mRS为0~2)占75.68%。手术相关并发症7例(17.5%),其中1例(2.5%)蛛网膜下腔出血,2例(5.0%)栓子逃逸,4例(10.0%)出现症状性的颅内出血,4例(10.0%)死亡,均为血管再通的患者。结论在以直接抽吸技术作为首选取栓策略时,远端通路导管在急性缺血性卒中机械取栓治疗方面相对安全,初步临床效果良好。

Objective To investigate the clinical effect and safety of distal access catheter on the treatment of acute isch⁃emic stroke(AIS)while using the direct aspiration technique as the preferred thrombectomy strategy.Methods Clinical data about 40 acute large vessel occlusion patients of undergoing the mechanical thrombectomy via distal access cathe⁃ter from January 2019 to December 2019 in People's Hospital of Baise was retrospectively analyzed.There were 25 male cases and 15 female cases.Patients were aged from 31 to 88,with an average value of(63.56±11.63)years old.17 cases had middle cerebral artery M1 occlusion(17 cases,42.5%),13 cases of internal carotid artery occlusion(13 cas⁃es,32.5%)and 10 cases of basilar artery occlusion(10 cases,25%).The vascular recanalization rate,treatment compli⁃cations and clinical prognosis after 90 d of treatment were analyzed.Patient's neurological function was evaluated through national institutes of health stroke scale(NIHSS),vascular recanalization conditions by modified Thrombolysis in Cerebral Infarction Score(mTICI)and clinical prognosis by Modified Rankin Scale(mRS).Results The median NI⁃HSS scores upon admission were 16.5(12.00,22.25)upon admission and 4(2,10)after discharge;the differences were statistically significant(P<0.01).37 cases had mTICI≥2b;the vascular recanalization rate was 92.5%.23 cases just took the aspiration(57.5%),19 cases with one-time vascular recanalization(82.61%).After 90 d of treatment,75.68%of patients had good prognosis(mRS=0~2);the surgical complication rate was 17.5%(7 cases),including one case of subarachnoid hemorrhage(2.5%),2 cases of escaped embolus(5.0%),4 cases of symptomatic intracranial hemorrhage(10.0%)and 4 dead cases with vascular recanalization(10.0%).Conclusion As long as the direct aspiration technique is recommended as the preferred thrombectomy strategy,the distal access catheter is proven to be safe during the throm⁃bectomy for AIS patients.