AcoStream血栓抽吸装置治疗急性下肢缺血6例

AcoStream thrombus aspiration device for acute lower limb ischemia in 6 cases

目的 探讨AcoStream血栓抽吸装置治疗急性下肢缺血(ALLI)的有效性和安全性。方法 回顾性分析2022年1月至2022年3月在南京市第一医院接受AcoStream血栓抽吸治疗的6例ALLI患者临床资料。技术成功定义为完成AcoStream取栓操作;临床成功定义为ALLI相关症状缓解。根据心肌梗死溶栓(TIMI)治疗后血流分级评估术后即刻血供,Cooley疗效评分标准评估临床疗效。出院后30 d随访手术相关并发症、截肢率、短期通畅率及死亡情况。结果 6例患者均完成取栓手术操作。3例联合Solitaire AB支架取栓,2例联合CDT,1例联合Solitaire AB支架取栓及CDT。1例伴有严重下肢动脉硬化患者术中行髂动脉球囊扩张术。TIMI分级术前0级2例,1级4例;术后即刻2级和3级各3例,其中3例联合CDT术后1 d复查TIMI分级均为3级。出院后30 d随访,患肢通畅6例;Cooley疗效评分显示痊愈3例,良好3例;无截肢、死亡。结论 AcoStream血栓抽吸装置治疗ALLI安全有效,具有重要的临床应用价值。

Objective To investigate the effectiveness and safety of AcoStream thrombus aspiration device in the treatment of acute lower limb ischemia(ALLI). Methods The clinical data of 6 patients with ALLI,who received AcoStream thrombus aspiration treatment at the Nanjing Municipal First Hospital of China between January and March of 2022, were retrospectively analyzed. The technical success was defined as the completion of the AcoStream thrombectomy operation, and the clinical success was defined as the certain remission of ALLI-related symptoms. The blood flow classification score after thrombolysis in myocardial infarction(TIMI) was used to evaluate the immediate postoperative blood supply, and Cooley efficacy scoring criteria was used to assess the clinical efficacy. The patients were followed up at 30 days after discharge, and the surgery-related complications, amputation rate, short-term patency rate, and death were recorded. Results The thrombectomy was accomplished in all the 6 patients. Combination use of the Solitaire AB stent was employed in 3 patients, combination use of catheter-directed thrombolysis(CDT) was carried out in 2 patients,and combination use of Solitaire AB stent thrombectomy plus CDT was adopted in one patient. Intraoperative balloon dilation of the iliac artery was performed in one patient who suffered from severe lower extremity arteriosclerosis. The preoperative TIMI grade 0 was seen in 2 patients and grade I was seen in 4 patients;the postoperative TIMI grade Ⅱ was obtained in 3 patients and grade Ⅲ was obtained in other 3 patients;3among the 6 patients received combination treatment of CDT and they achieved TIMI grade Ⅲ one day after treatment. Thirty days after discharge, the blood vessels in the affected limb were unobstructed in all the 6patients;Cooley efficacy scoring showed that recovery was obtained in 3 patients and good outcome was obtained in other 3 patients;no amputation was needed, and no death occurred. Conclusion For the treatment of ALLI, AcoStream thrombus aspiration device is clinically safe and effective, therefore, it has an important clinical application value.(J Intervent Radiol, 2022, 31: 1151-1154)