不同型号Sofia导管在脑动脉血栓直接抽吸术中的临床应用

Safety and efficacy of different types of Sofia Catheters for a direct aspiration first pass technique

目的对比分析不同型号Sofia导管在脑动脉血栓直接抽吸术中的安全性及疗效。方法回顾性收集2019年8月至2021年6月在潍坊市人民医院应用Sofia导管行脑动脉血栓直接抽吸术的76例急性缺血性脑卒中患者,将基底动脉取栓患者(36例)和大脑中动脉M1段及颈内动脉取栓患者(40例)分别分为5F Sofia导管组及6F Sofia导管组,分别对比分析2组患者应用不同型号导管的脑动脉再通成功率、血栓逃逸率、美国国立卫生研究院卒中量表(NIHSS)评分差值、预后、术后脑出血率及术后死亡率,并通过t检验及Fisher确切概率法对不同型号导管组相关资料进行差异性检验。结果应用5F Sofia导管在大脑中动脉M1段及颈内动脉取栓的血栓逃逸率为20.00%(3/15),应用6F Sofia导管的血栓逃逸率为4.00%(1/25),两者差异具有统计学意义(P=0.045);脑动脉再通成功率、术后脑出血率、NIHSS评分差值及良好预后方面比较,差异均无统计学意义(P均>0.05)。应用5F Sofia导管在基底动脉取栓组中脑动脉再通成功率为86.36%(19/22),高于6F Sofia导管脑动脉再通成功率[50.00%(7/14)],差异具有统计学意义(P=0.026),因6F Sofia导管再通失败采用补救措施,导致再通时间延长,良好预后率明显低于5F Sofia导管[35.71%(5/14)vs 72.73%(16/22)],差异具有统计学意义(P=0.041);术后脑出血率、血栓逃逸率和术后死亡率方面比较,差异均无统计学意义(P均>0.05)。结论大脑中动脉M1段及颈内动脉闭塞首选6F Sofia导管,基底动脉闭塞首选5F Sofia导管,正确选择Sofia导管型号可降低血栓逃逸率,提高脑动脉再通成功率,改善患者预后。

Objective To compare the safety and clinical efficacy of different types of Sofia catheters in treating acute ischemic stroke.Methods The clinical data of 76 patients with acute ischemic stroke treated with a direct aspiration first pass technique in Weifang People′s Hospital form August 2019 to June 2021 were included.The patients with basilar artery occlusions(36 cases)and the patients with M1 segment of middle cerebral artery occlusions or internal carotid occlusions(40 cases)were divided into two groups:the group of 5F Sofia catheter and the group of 6F Sofia catheter.The levels of recanalization,thrombosis escape rate,National Institute of Health stroke scale(NIHSS)score change,clinical prognosis,bleeding rate,and mortality were compared between the two groups.The relevant data of different models were tested by t-test and Fisher′s exact probability method.Results The thrombosis escape rate of 5F Sofia catheter was 20.00%(3/15),while that of 6F Sofia catheter was 4.00%(1/25),showing significant difference(P=0.045).There was no significant difference in the levels of recanalization,bleeding rate,NIHSS score difference,or clinical prognosis between the patients with M1 segment of middle cerebral artery occlusion or internal carotid occlusion(P>0.05).The success rate of recanalization of 5F Sofia catheter was 86.36%(19/22),while that of 6F Sofia catheter was 50.00%(7/14),showing significant difference(P=0.026).Because of the 6F Sofia catheter reopening failure,the good prognosis was significantly lower than the 5F Sofia catheter[35.71%(5/14)vs 72.73%(16/22),P=0.041].There was no significant difference in the levels of bleeding rate,thrombosis escape rate and mortality rate between the patients with basilar artery occlusion(P>0.05).Conclusion It is suggested that M1 segment of middle cerebral artery occlusion or internal carotid artery occlusion should be treated with 6F Sofia catheter and basilar artery thrombosis with 5F Sofia catheter.A suitable catheter can improve the prognosis.