Catalyst6颅内支撑导管联合支架取栓术治疗急性缺血性脑卒中的疗效观察

Efficacy of Catalyst6 intracranial bracing catheter combined with stent thrombectomy in acute ischemic stroke

目的比较单纯支架取栓及Catalyst6颅内支撑导管负压抽吸联合支架取栓两种取栓手术的疗效,为急性缺血性脑卒中(AIS)患者机械取栓术中具体操作流程和技术改进提供参考依据。方法回顾性研究2017年1月至2022年1月成都西区医院和西部战区总医院收治的132例AIS患者的临床资料,按不同手术方案分为观察组(采用Catalyst6颅内支撑导管联合支架取栓,67例)和对照组(采用单纯支架取栓,65例)。比较2种不同手术操作流程及方法在手术安全性及有效性指标方面的差异。结果观察组患者取栓1次责任血管成功开通率[79.1%(53/67)]、术后90 d良好预后率[49.3%(33/67)]均明显高于对照组[分别为61.5%(40/65)、30.8%(20/65)],术后90 d内死亡率[10.4%(7/67)]、血栓远端逃逸率[1.5%(1/67)]均明显低于对照组[分别为29.2%(19/65)、10.8%(7/65)],差异均有统计学意义(P<0.05);总手术时间[(90.60±24.94)min]、术后24 h内颅内出血率[2.9%(2/67)]、术后24 h内脑疝形成率[2.9%(2/67)]、术后24 h内病死率[1.5%(1/67)]与对照组[分别为(88.67±22.93)min、6.2%(4/65)、4.6%(3/65)、3.1%(2/65)]比较,差异均无统计学意义(P>0.05)。结论在AIS中从手术操作有效性及安全性指标分析联合取栓组在症状性颅内出血、术后24 h脑疝、术后24 h内病死率等安全性指标方面无差异,没有增加手术时间,但提高了靶血管1次开通率,减少了术中血栓逃逸,具有更好的短期内及长期预后。

Objective To compare the efficacy of simple stent thrombectomy and negative pressure suction of Catalyst6 intracranial bracing catheter combined with stent thrombectomy,and to provide some references for the specific operational process and technical improvement of mechanical thrombectomy in patients with acute ischemic stroke(AIS).Methods The clinical data of 132 patients with AIS admitted to the Chengdu Western Hospital and the General Hospital of Western Theater Command from January 2017 to January 2022 were retrospectively studied.These patients were divided into the control group(Simple stent thrombectomy was performed in 65 cases)and the observation group(Catalyst6 intracranial bracing catheter combined with stent thrombectomy was performed in 67 patients)according to different surgical methods.The effectiveness and safety of the two surgical procedures and methods were compared.Results The successful opening rate of responsible vessels after 1 thrombectomy in the observation group[79.1%(53/67)]and the good prognosis rate at 90 days after thrombectomy[49.3%(33/67)]were significantly higher than those in the control group[61.5%(40/65)and 30.8%(20/65),respectively];The mortality within 90 days after operation[10.4%(7/67)]and the distal escape rate of thrombus[1.5%(1/67)]were significantly lower than those of the control group[29.2%(19/65)and 10.8%(7/65),respectively],and the differences were statistically significant(P<0.05).There were no significant differences in total operation time[(90.60±24.94)min vs.(88.67±22.93)min],intracranial hemorrhage rate within 24 h after operation[2.9%(2/67)vs.6.2%(4/65)],cerebral hernia rate within 24 h after operation[2.9%(2/67)vs.4.6%(3/65)],the mortality within 24 h after operation[1.5%(1/67)vs.3.1%(2/65)]between the observation group and the control group(P>0.05).Conclusion In AIS,the results of the efficacy and safety of operation indicators have showed there was no difference in symptomatic intracranial hemorrhage,cerebral hernia within 24 h after operation,and mortality within 24 h after operation between the combined thrombectomy group and the simple stent thrombectomy group.Combined thrombectomy does not increase the operation time,but improves the opening rate of target vessels after 1 thrombectomy,reduces the intraoperative thrombus escape,and has better short-term and long-term prognosis.