双腔微导管在颈内动脉慢性闭塞再通治疗中的应用

Application of Double-lumen Microcatherter in Endovascular Recanalization of Chronic Internal Carotid Artery Occlusion

目的探讨双腔微导管在颈内动脉慢性闭塞病变血管再通治疗中应用的可行性、安全性和技术优势。方法回顾性分析2020年1-12月于大连市中心医院应用双腔微导管血管再通治疗的慢性颈内动脉闭塞患者的临床资料。观察术后即刻血管再通情况(mTICI分级),术后30 d及术后6~10个月随访期间卒中(缺血性卒中和出血性卒中)事件和支架再闭塞率。结果共纳入颈内动脉慢性闭塞患者6例,年龄43~83岁,其中男性5例(83.3%),女性1例(16.7%)。长节段闭塞(闭塞段从颈内动脉起始处延伸到C5段远端以上)1例(16.7%)。临床表现为缺血性卒中5例(83.3%),反复TIA 1例(16.7%)。术前NIHSS 1~5分,mRS 1~2分。6例患者(100%)术后均达到mTICI 3级再通。术后2例(33.3%)血管残存狭窄<20%,4例(66.7%)残存狭窄<10%。随访期间无任何卒中或死亡事件,6个月随访mRS 0~1分。结论双腔微导管用于颈内动脉慢性闭塞病变的血管再通治疗可能是安全有效的,是值得进一步探索的一种治疗手段。

Objective To explore the feasibility,safety and technical advantages of dual-lumen microcatheter in endovascular recanalization of chronic internal carotid artery occlusion(CICAO).Methods The clinical data of patients with CICAO who were treated with double-lumen microcatheter revascularization at Dalian Municipal Central Hospital from January to December 2020 were retrospectively analyzed.The immediate postoperative revascularization(mTICI),any stroke events(including ischemic and hemorrhagic stroke)and stent re-occlusion were observed at 30 days and during the 6-to 10-month after the procedure.Results A total of 6 eligible patients aged 43 to 83 years were included,with 5 males(83.3%)and 1 female(16.7%).There was 1(16.7%)case with long segmental occlusion(occluded segment extending from the initial segment of internal carotid artery to above the distal C5 segment).The clinical presentation was ischemic stroke in 5 cases(83.3%)and recurrent TIA in 1 case(16.7%).Preoperative NIHSS scores ranged from 1 to 5,and mRS scores ranged from 1 to 2.All patients(6/6,100%)achieved mTICI grade 3 recanalization after the procedure.2 cases(33.3%)had residual stenosis<20%and 4 cases(66.7%)had residual stenosis<10%after the procedure.There were no stroke or death events during the follow-up period,and mRS score at the 6-month follow-up was 0-1.Conclusions Dual-lumen microcatheter for revascularization of chronic occlusion of internal carotid artery may be safe and effective.