远端通过导管推越技术机械取栓治疗大脑中动脉M1段急性闭塞

Mechanical thrombectomy with advancing distal access catheter over stent retriever technique for treating acute occlusion of middle cerebral artery M1 segment

目的观察将治疗时间窗延长至16 h并以远端通过导管推越(ADVANCE)技术机械取栓治疗大脑中动脉M1段急性闭塞的效果。方法回顾性分析60例因大脑中动脉M1段或颈内动脉合并大脑中动脉M1段闭塞(发病至介入治疗动脉穿刺时间≤16 h)而接受数字减影血管造影(DSA)引导下机械取栓治疗的急性缺血性脑卒中患者,其中28例以ADVANCE技术首次取栓(观察组)、32例以血栓抽吸术取栓(对照组),对比组间疗效及并发症。结果观察组术后血管再通成功率[89.29%(25/28)]与对照组[93.75%(30/32)]差异无统计学意义(P=0.876)。观察组首过效应(FPE)率高于对照组,首次血管再通取栓次数及穿刺至血管开通时间均少于对照组(P均<0.05)。术后1周美国国立卫生研究院卒中量表(NIHSS)评分及术后90天预后良好率组间差异均无统计学意义(P均>0.05)。观察组术中血管痉挛发生率低于对照组(P<0.05),2组颅内出血、远端栓塞、新发梗死及死亡率差异均无统计学意义(P均>0.05)。结论将治疗时间窗延长至16 h,以ADVANCE技术机械取栓治疗大脑中动脉M1段急性闭塞安全、有效。

Objective To observe the efficacy of mechanical thrombectomy with advancing distal access catheter over the stent retriever(ADVANCE)technique for treating acute occlusion of middle cerebral artery M1 segment at the time window extended to 16 h.Methods Data of 60 symptom onset≤16 h acute ischemic stroke patients due to occlusion of middle cerebral artery M1 segment or internal carotid artery with middle cerebral artery M1 segment who underwent digital subtraction angiography guided mechanical thrombectomy were retrospectively analyzed.Among them,28 cases who underwent first thrombectomy using ADVANCE technique were divided into observation group,while the rest 32 cases who underwent thrombi aspiration were enrolled in control group.The therapeutic efficacy of treatments and complications were compared between groups.Results There was no significant difference of success rate of vascular recanalization in observation group(89.29%[25/28])and control group(93.75%[30/32],P=0.876).The first-pass effect(FPE)rate of observation group was higher than that of control group,while the times of first vascular recanalization and the time from puncture to vessel recanalization in observation group were all less than those in control group(all P<0.05).No significant difference of National Institutes of health stroke scale score 1 week after treatment nor good prognosis rate 90 days after treatment was found between groups(both P>0.05).The incidence of intraoperative vasospasm in observation group was lower than that in control group(P<0.05).There was no significant difference of complication incidence,such as intracranial hemorrhage,distal embolism,new infarction nor death between groups(all P>0.05).Conclusion Mechanical thrombectomy with ADVANCE technology for acute occlusion of middle cerebral artery M1 segment was effective and safe even when the treatment time window were extended to 16 h.