小球囊联合长鞘半逆行开通在动脉粥样硬化性颈动脉急性串联病变患者中的初步应用

Preliminary application of small balloon combined with long sheath by“half”retrograde approach in patients with atherosclerotic tandem lesions of internal carotid artery

目的 探讨小球囊联合长鞘半逆行开通治疗动脉粥样硬化性颈动脉串联病变所致急性缺血性卒中的安全性和有效性。方法 回顾性分析武汉市第一医院高级卒中中心2018年5月至2022年4月收治的40例动脉粥样硬化性颈动脉串联病变所致的急性缺血性卒中患者的病历资料,40例患者依据治疗方法不同分为小球囊联合长鞘组18例和PEARS技术组22例。PEARS技术依次按照保护(Protect)—球囊扩张(Expand)—抽吸(Aspiration)—取栓(Revascularization)—支架(Stent)的顺序处理颈动脉串联病变,小球囊联合长鞘为在PEARS技术基础上利用小球囊和长鞘的特点减少操作步骤。记录所有患者的基线资料以及股动脉穿刺至血管再通时间、血管成功再通率、首次血管成功再通率、术后90 d良好预后(改良Rankin量表评分≤2分)率、症状性颅内出血(sICH)发生率和病死率,并进行组间比较。结果 小球囊联合长鞘组患者股动脉穿刺至血管再通时间少于PEARS技术组[(66±31) min比(104±33) min],差异有统计学意义(t=3.683,P=0.001)。小球囊联合长鞘组的首次血管成功再通患者比例与PEARS技术组比较,差异无统计学意义(13/18比10/22,χ~2=2.903,P=0.088)。小球囊联合长鞘组首次血管成功再通的13例患者中,7例病变部位为起始端串联颈动脉末端闭塞。两组间的基线资料、血管再通成功率、术后90 d良好预后率、症状性颅内出血发生率和病死率差异均无统计学意义(均P>0.05)。结论 小球囊联合长鞘半逆行开通可尝试用于治疗动脉粥样硬化性颈动脉串联病变所致的急性缺血性卒中,尤其是颈内动脉起始端和末端急性串联病变患者,期待未来更多的研究进一步明确。

Objective To investigate the safety and efficacy of small balloon combined with long sheath by “half” retrograde approach in acute ischemic stroke caused by the atherosclerotic tandem lesions of internal carotid artery. Methods The medical history data of patients with acute ischemic stroke caused by atherosclerotic tandem lesions of internal carotid artery admitted to the Department of Neurology, Wuhan No.1 Hospital from May 2018 to April 2022 were retrospectively analyzed. The patients were divided into small balloon combined with long sheath group(18 cases) and PEARS(Protect-Expand-Aspiration-Revascularization-Stent) technique group(22 cases). PEARS technique was used to deal with the tandem lesions of carotid arteries in the order of protection, expansion, aspiration, revascularization and stenting. Based on PEARS technique, small balloon combined with long sheath is to reduce the operation steps through the characteristics of small balloon and long sheath.The baseline data, the time from puncture to immediate revascularization, the rate of successful revascularization, the rate of successful revascularization after first pass, favorable prognosis rate at 90 days(modified Rankin scale score [mRS]≤2), the incidence of symptomatic intracranial hemorrhage(sICH) and all-cause mortality were recorded. Results The time from femoral artery puncture to revascularization in the small balloon combined with long sheath group was significantly less than that in the PEARS technique group([66±31] min vs. [104±33] min, t=3.683, P=0.001). Besides, compared with the PEARS technique group, the small balloon combined with long sheath group showed no significance in the rate of successful revascularization after first pass(13/18 vs. 10/22, χ~2=2.903, P=0.088). Seven of the thirteen patients with first-pass revascularization in the small balloon and long sheath group had their occlusion site in the C1 segment and the terminal of the internal carotid artery. There were no significant differences in baseline data, rate of successful revascularization, favorable prognosis rate at 90 days, the incidence of sICH and all-cause mortality between the two groups(all P>0.05). Conclusion This preliminary study indicate that small balloon combined with long sheath “half” retrograde approach may be applied in the treatment of acute ischemic stroke caused by atherosclerotic tandem lesions of internal carotid artery, which may be more suitable for patients with acute series occlusion of the C1 segment and the terminal of the internal carotid artery, but more research is needed to prove the point.