症状性颈内动脉非急性闭塞开通治疗微栓子监测研究

Microembolus monitoring after endovascular recanalization of symptomatic non-acute internal carotid artery oc⁃clusion

目的 对症状性颈内动脉非急性闭塞(NA-ICAO)开通治疗中的微栓子(microemboli signal,MES)数量进行监测,遴选术中发生MES的危险步骤,以提高血管内治疗(EVT)的安全性。方法 收集2022年4月1日—2023年6月30日期间,就诊于河南省人民医院的56例患有症状性颈内动脉非急性闭塞并接受EVT的患者进行了前瞻性数据收集。并分别于再灌注治疗的7个步骤中记录了MES发生的次数,使用经颅多普勒(TCD)进行统计。所有患者均接受术前和术后磁共振成像(MRI)检查。据MES结果以及术后患者扩散加权成像(DWI)中是否存在新的梗死灶,将其分为两组:DWI阳性(+)和DWI阴性(-)。结果 两组患者术中MES产生数量较多步骤均为微导丝通过闭塞段探寻真腔(均数21.81、17.75,P<0.05)、第1次预扩张(均数23.29、17.43,P<0.05)操作;且术后有新发梗死灶与术中MES总数具有显著正相关性。结论 闭塞开通术中微导丝通过闭塞段探寻真腔、球囊预扩张很可能会诱发MES。在手术过程中MES的数量与术后并发性梗死灶有显著相关性。推测术中MES与患者术后新发梗死灶有关。

Objective To monitor the number of microembolic signals(MES)during endovascular recanalization of symptomatic non-acute internal carotid artery occlusion(NA-ICAO),to investigate the risk steps for MES during sur-gery,and to improve the safety of endovascular treatment(EVT).Methods A prospective study was conducted among 56 patients with symptomatic NA-ICAO who received EVT from April 1,2022 to June 30,2023.The number of MES was recorded during the seven steps of reperfusion treatment,and transcranial Doppler was used for statistical analysis.All pa-tients underwent magnetic resonance imaging before and after surgery.According to the results of MES and the presence or absence of new infarcts on diffusion-weighted imaging(DWI)after surgery,the patients were divided into DWI(+)group and DWI(-)group.Results A relatively large number of MES was observed for both groups in the steps of searching for the true cavity through the occlusive segment with microguide wire(with a mean number of 21.81 and 17.75,respec-tively;P<0.05)and predilation for the first time(with a mean number of 23.29 and 17.43,respectively;P<0.05),and the number of new infarcts after surgery was significantly positively correlated with the total number of MES during surgery.Conclusion The steps of searching for the true cavity through the occlusive segment with microguide wire and predilation for the first time may easily induce MES,and the number of MES during surgery is correlated with infarcts after surgery.It is speculated that intraoperative MES is associated with new infarcts after surgery.