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中华脑血管病杂志(电子版)

中华脑血管病杂志(电子版) ›› 2023, Vol. 17 ›› Issue (02) : 102 -106. doi: 10.11817/j.issn.1673-9248.2023.02.004

临床研究

支架取栓与血栓直接抽吸技术在急性脑动脉闭塞再通中的疗效比较
李伟1, 王清波2, 马飞飞3, 郭晖1, 庞春晓1,†()   
  1. 1. 261500　山东潍坊，潍坊市人民医院神经外科
    2. 261500　山东潍坊，潍坊市人民医院介入放射科
    3. 262737　山东潍坊，潍坊经济开发区人民医院神经外科
  • 收稿日期:2022-08-23 出版日期:2023-04-01
  • 通信作者: 庞春晓
  • 基金资助:
    潍坊市科技发展计划项目(2018YX048)

Efficacy comparison between stent retriever and a direct aspiration first pass technique for acute ischemic stroke

Wei Li1, Qingbo Wang2, Feifei Ma3, Hui Guo1, Chunxiao Pang1,†()   

  1. 1. Neurosurgery, People's Hospital of Weifang Binhai Economic and Technological Development Zone, Weifang 262737, China; Department of Neurosurgery, Weifang People's Hospital, Weifang 261500, China
    2. Neurosurgery, People's Hospital of Weifang Binhai Economic and Technological Development Zone, Weifang 262737, China
    3. Neurosurgery, People's Hospital of Weifang Binhai Economic and Technological Development Zone, Weifang 262737, China; Interventional Radiology, Weifang People's Hospital, Weifang 261500, China
  • Received:2022-08-23 Published:2023-04-01
  • Corresponding author: Chunxiao Pang
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引用本文：

李伟, 王清波, 马飞飞, 郭晖, 庞春晓. 支架取栓与血栓直接抽吸技术在急性脑动脉闭塞再通中的疗效比较[J]. 中华脑血管病杂志(电子版), 2023, 17(02): 102-106.

Wei Li, Qingbo Wang, Feifei Ma, Hui Guo, Chunxiao Pang. Efficacy comparison between stent retriever and a direct aspiration first pass technique for acute ischemic stroke[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2023, 17(02): 102-106.

目的

对比分析支架取栓与血栓直接抽吸技术在急性脑动脉闭塞再通中的临床疗效。

方法

回顾性分析2019年8月至2020年12月在潍坊市人民医院行机械取栓术的40例患者。其中19例患者采用支架取栓（支架取栓组），21例患者采用血栓直接抽吸技术（血栓直接抽吸组）。采用独立样本t检验或Fisher确切概率检验比较2组患者脑动脉再通成功率、手术时间、美国国立卫生研究院卒中量表（NIHSS）评分差值、血栓逃逸发生率、术后脑出血发生率、术后1个月预后良好比例及术后死亡率的差异。

结果

2组患者心源性因素、脑动脉狭窄、高血压、糖尿病及重大手术后并发症等差异均无统计学意义（P均＞0.05）。支架取栓组与血栓直接抽吸组患者脑动脉再通成功率[89.5%（17/19）vs 85.7%（18/21）]、手术时间[（96.8±16.2）min vs（93.0±13.5）min]、NIHSS评分差值（术前-术后）[（5.6±4.6）分 vs（5.8±4.1）分]、血栓逃逸发生率[10.5%（2/19）vs 4.8%（1/21）]、术后脑出血发生率[15.8%（3/19）vs 4.8%（1/21）]、术后1个月预后良好比例[52.6%（10/19）vs 47.6%（10/21）]及术后死亡率[26.3%（5/19）vs 14.3%（3/21）]比较，差异均无统计学意义（P=1.00；t=0.828，P=0.413；t=187.5，P=0.752；P=0.596；P=0.331；P=1.000；P=0.442）。

结论

支架取栓与血栓直接抽吸技术治疗急性脑动脉闭塞均具有较好的临床疗效。

关键词: 支架取栓, 血栓直接抽吸技术, 脑动脉再通
Objective

To compare the clinical efficacy of the stent retriever with that of the a direct aspiration first pass technique（ADAPT）in the treatment of acute ischemic stroke with cerebral artery occlusions.

Methods

The clinical data of 40 patients who underwent mechanical thrombectomy in our hospital from Aug 2019 to Dec 2020 were retrospectively selected and divided into two groups. Among them, 19 patients were treated with stent retrievers, and the other 21 patients were treated with ADAPT. The success rate of recanalization, operation time, NIHSS score, thrombosis escape rate, postoperative cerebral hemorrhage rate, the proportion of good prognosis at one month after the operation, and postoperative mortality were compared between the two groups.

Results

There was no significant difference in coronary heart disease, cerebral arterial stenosis, hypertension, diabetes, and major postoperative complication between the two groups (P＞0.05). There was no significant difference in the success rate of recanalization [89.5% (17/19) vs 85.7% (18/21)], operation time [(96.8±16.2) min vs (93.0±13.5) min], NIHSS score [(5.6±4.6) score vs (5.8±4.1) score], thrombosis escape rate [10.5% (2/19) vs 4.8%(1/21)], postoperative cerebral hemorrhage rate [15.8% (3/19) vs 4.8% (1/21)], the proportion of good prognosis at one month after operation [52.6% (10/19) vs 47.6% (10/21)], and postoperative mortality [26.3% (5/19) vs 14.3% (3/21)] between the two groups (P=1.00; t=0.828, P=0.413; t=187.5, P=0.752; P=0.596; P=0.331; P=1.000; P=0.442).

Conclusion

Both the stent retriever and ADAPT have good clinical efficacy in the treatment of acute ischemic stroke with cerebral artery occlusions.

Key words: Stent retriever, A direct aspiration first pass technique, Recanalization
图1 急性脑动脉闭塞患者支架取栓造影图。图a为左侧颈总动脉造影显示左侧颈内动脉闭塞；图b为右侧颈内动脉造影显示左侧大脑中动脉M2段闭塞；图c显示Solitaire支架取栓，确定微导管在动脉真腔内，血栓远端动脉通畅；图d显示血栓逃逸，M2远端动脉显影，图b中显影的分支动脉（白色圆圈）在图d中闭塞（白色圆圈）
图2 急性脑动脉闭塞患者血栓直接抽吸技术造影图。图a显示右侧颈内动脉远端闭塞；图b为Sofia导管直接抽吸血栓后造影；图c为血栓
表1 2组急性脑动脉闭塞患者基础疾病及危险因素比较
组别 例数 年龄（岁，
x¯
±s）		 性别（例，男性/女性） 心源性因素[例（%）] 脑动脉狭窄[例（%）] 高血压[例（%）] 糖尿病[例（%）] 重大手术后并发症[例（%）]
支架取栓组 19 56.5±4.7 11/8 10（52.6） 7（36.8） 7（36.8） 10（52.6） 1（5.3）
血栓直接抽吸组 21 57.9±3.5 12/9 13（61.9） 8（38.1） 10（47.6） 7（33.3） 3（14.3）
统计值 t=1.101 - - - - - -
P值 0.278 1.000 0.750 1.000 0.538 0.338 0.607
表2 2组急性脑动脉闭塞患者取栓疗效比较
组别 例数 脑动脉再通成功[例（%）] 手术时间（min，
x¯
±s）		 NIHSS评分差值（分，
x¯
±s）		 血栓逃逸[例（%）] 术后脑出血[例（%）] 术后1个月预后良好[例（%）] 术后死亡[例（%）]
支架取栓组 19 17（89.5） 96.8±16.2 5.6±4.6 2（10.5） 3（15.8） 10（52.6） 5（26.3）
血栓直接抽吸组 21 18（85.7） 93.0±13.5 5.8±4.1 1（4.8） 1（4.8） 10（47.6） 3（14.3）
统计值 - t=0.828 t=187.5 - - - -
P值 1.00 0.413 0.752 0.596 0.331 1.000 0.442
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