经桡动脉入路机械取栓术治疗急性颅内大血管闭塞的疗效观察

Efficacy of mechanical thrombectomy transradial access for acute intracranial large vascular occlusion

目的观察经桡动脉入路机械取栓术治疗急性颅内大血管闭塞的临床疗效。方法回顾性分析2016年6月至2020年12月南京医科大学附属无锡第二医院神经外科采用经股动脉入路失败后改为经桡动脉入路机械取栓术治疗急性颅内大血管闭塞患者的临床资料, 共15例。观察经桡动脉入路建立手术通道情况、术后即刻血管再通情况[改良脑梗死溶栓(mTICI)分级≥2b级为再通] 、手术相关并发症;术后90 d采用改良Rankin量表评分(mRS)评估患者的预后(0~2分为预后良好, 3~6分为预后不良)。结果 15例患者均成功经桡动脉入路建立手术入路。其中14例患者完成机械取栓术, 血管均成功再通;1例患者因血栓逃逸至远端血管未能再通。患者均未出现手术相关并发症;术后90 d随访, 无一例患者死亡, 其中5例患者预后良好, 10例预后不良。结论经桡动脉入路机械取栓术治疗急性颅内大血管闭塞手术成功率高、风险低, 是股动脉入路失败后的重要补救措施。

Objective To observe the therapeutic effect of mechanical thrombectomy transradial access for acute intracranial large vascular occlusion.Methods A retrospective analysis was conducted on the clinical data of 15 patients with acute intracranial large-vessel occlusion at the Department of Neurosurgery,Wuxi Second Hospital Affiliated to Nanjing Medical University from June 2016 to December 2020.Those patients underwent mechanical thrombectomy transradial access after failed transfemoral access.We observed the establishment of surgical channels transradial access,the immediate postoperative vascular recanalization[modified thrombolysis in cerebral infarction(mTICI)≥2b for recanalization]and surgery-related complications.Patients′outcomes were assessed using the modified Rankin scale score(mRS)90 days postoperatively(0-2 points for good outcomes prognosis and 3-6 for poor outcomes).Results All 15 patients underwent successful establishment of a surgical channel transradial access.Among them,14 patients completed mechanical thrombectomy,and the blood vessels achieved successful recanalization,and 1 patient failed in recanalization due to thrombosis escape to the distal blood vessels.None of the patients developed surgery-related complications.After 90 days of follow-up,none of the patients died,of which 5 patients had a good outcome and 10 patients had a poor outcome.Conclusion Mechanical thrombectomy transradial access for the treatment of acute intracranial large vessel occlusion has a high success rate and low risk,which is an important remedy after the failure of the transfemoral access.