Solumbra技术在急性大动脉闭塞性脑梗死机械取栓中的初步应用观察
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摘要
目的探讨Solumbra技术在急性大动脉闭塞性脑梗死机械取栓治疗中应用的可行性、有效性、安全性和技术优势。方法回顾性分析2016年1月至2017年12月采用血管内机械取栓治疗的59例急性大动脉闭塞性脑梗死患者临床资料。其中接受中间导管联合支架取栓患者31例(Solumbra组),接受常规导引导管联合支架取栓患者28例(常规支架取栓组)。比较两组患者手术相关指标、并发症及临床结果,分析Solumbra技术优势。结果 Solumbra组、常规支架取栓组患者间性别、年龄、术前美国国立卫生研究院卒中量表(NIHSS)评分、发病至动脉穿刺时间(OPT)、侧支循环评分差异均无统计学意义(P>0.05);颈内动脉(ICA)闭塞患者(12/31对2/28,χ2=8.100,P=0.004)、伴心房颤动患者(15/31对6/28,χ~2=4.66,P=0.031)差异有显著统计学意义;血管最终成功再通达到改良脑梗死溶栓(m TICI)治疗后血流评分标准2b/3级比例分别为93.5%、85.7%,一次取栓再通率达mTICI评分标准2b/3级比例分别为45.2%、25%,差异均无统计学意义(P>0.05);取栓次数[2 (1,2)对2 (1.25,3),Z=-2.177,P=0.029]、二次栓塞率(23.8%对39.3%,χ~2=3.991,P=0.046)、穿刺至再灌注时间(PRT)[(81±31) min对(100±35) min,t=2.315,P=0.028]差异均有统计学意义;颅内出血发生率分别为19.4%、10.7%(P>0.05),90 d良好预后率[改良Rankin量表(mRS)评分≤2]分别为48.4%、46.4%(P>0.05)。Solumbra组、常规支架取栓组ICA闭塞患者血管最终再通率分别为83.3%、0%(χ~2=5.833,P=0.016);90 d良好预后率分别为41.6%、0%(P>0.05),但Solumbra组占优。结论 Solumbra技术是一种治疗急性大动脉闭塞性脑梗死的安全有效方法 ,与传统支架取栓术相比取栓效率更高,推荐用于一些路径血管迂曲、血栓负荷量大的患者。
Objective To investigate the feasibility, effectiveness, safety and technological superiority of Solumbra technique for mechanical thrombectomy in patients with acute large cerebral artery occlusion stroke. Methods The clinical data of a total of 59 patients with acute large cerebral artery occlusion stroke, who were treated with endovascular mechanical thrombectomy during the period from January 2016 to December 2017, were retrospectively analyzed. Of the 59 patients, 31 received intermediate catheter combined with stent thrombectomy(Solumbra group) and 28 received conventional guide-catheter combined with stent thrombectomy(conventional stent thrombectomy group). The surgery-related indexes,complications and clinical results were compared between the two groups. The technological superiority of Solumbra technique was evaluated. Results No statistically significant differences in sex, age, NIHSS score, onset-to-puncture time(OPT) and collateral circulation score existed between the two groups(P>0.05),while statistically significant differences in the number of patients with internal carotid artery(ICA) occlusion(12/31 vs 2/28, χ~2=8.100, P=0.004) and the number of patients with atrial fibrillation(15/31 vs 6/28, χ~2=4.66, P =0.031) existed between the two groups. The proportions of patients who achieved successful revascularization that reached 2 b/3 grade of blood flow scoring standard after modified modified thrombolysis in cerebral infarction(mTICI) in the Solumbra group and in the conventional stent thrombectomy group were93.5% and 85.7% respectively, and the up-to-standard revascularization rates with single thrombectomy procedure in the Solumbra group and in the conventional stent thrombectomy group were 45.2% and 25%respectively, both differences were not statistically significant(both P>0.05). In the Solumbra group and the conventional stent thrombectomy group, the numbers of thrombectomy time were 2(1, 2) and 2(1.25, 3)respectively(Z=-2.177, P=0.029), the secondary embolization rates were 23.8% and 39.3% respectively(χ~2=3.991, P=0.046), the puncture-to-reperfusion time(PRT) were(81±31) min and(100±35) min respectively(t=2.315, P=0.028), the differences in all the above indexes were statistically significant; the incidences of intracranial hemorrhage were 19.4% and 10.7% respectively(P >0.05), the 90-day good prognosis(mRS score≤2 points) rates were 48.4% and 46.4% respectively(P>0.05). The final recanalization rates of blood vessel in patients with IAC occlusion were 83.3% and 0% respectively( χ~2=5.833, P=0.016), the 90-day good prognosis(mRS score≤2 points) rates were 41.6% and 0% respectively(P>0.05), in aspect of above indexes the Solumbra group was superior to the conventional stent thrombectomy group. Conclusion For endovascular recanalization of acute large cerebral artery occlusion stroke, Solumbra thrombectomy technique is safe and effective. The thrombectomy efficiency of Solumbra is higher than that of conventional stent-retriever thrombectomy. It is recommended that Solumbra technique should be used in some patients with circuitous pathways and high thrombus load.(J Intervent Radiol, 2019, 28: 515-520)
Objective To investigate the feasibility, effectiveness, safety and technological superiority of Solumbra technique for mechanical thrombectomy in patients with acute large cerebral artery occlusion stroke. Methods The clinical data of a total of 59 patients with acute large cerebral artery occlusion stroke, who were treated with endovascular mechanical thrombectomy during the period from January 2016 to December 2017, were retrospectively analyzed. Of the 59 patients, 31 received intermediate catheter combined with stent thrombectomy(Solumbra group) and 28 received conventional guide-catheter combined with stent thrombectomy(conventional stent thrombectomy group). The surgery-related indexes,complications and clinical results were compared between the two groups. The technological superiority of Solumbra technique was evaluated. Results No statistically significant differences in sex, age, NIHSS score, onset-to-puncture time(OPT) and collateral circulation score existed between the two groups(P>0.05),while statistically significant differences in the number of patients with internal carotid artery(ICA) occlusion(12/31 vs 2/28, χ~2=8.100, P=0.004) and the number of patients with atrial fibrillation(15/31 vs 6/28, χ~2=4.66, P =0.031) existed between the two groups. The proportions of patients who achieved successful revascularization that reached 2 b/3 grade of blood flow scoring standard after modified modified thrombolysis in cerebral infarction(mTICI) in the Solumbra group and in the conventional stent thrombectomy group were93.5% and 85.7% respectively, and the up-to-standard revascularization rates with single thrombectomy procedure in the Solumbra group and in the conventional stent thrombectomy group were 45.2% and 25%respectively, both differences were not statistically significant(both P>0.05). In the Solumbra group and the conventional stent thrombectomy group, the numbers of thrombectomy time were 2(1, 2) and 2(1.25, 3)respectively(Z=-2.177, P=0.029), the secondary embolization rates were 23.8% and 39.3% respectively(χ~2=3.991, P=0.046), the puncture-to-reperfusion time(PRT) were(81±31) min and(100±35) min respectively(t=2.315, P=0.028), the differences in all the above indexes were statistically significant; the incidences of intracranial hemorrhage were 19.4% and 10.7% respectively(P >0.05), the 90-day good prognosis(mRS score≤2 points) rates were 48.4% and 46.4% respectively(P>0.05). The final recanalization rates of blood vessel in patients with IAC occlusion were 83.3% and 0% respectively( χ~2=5.833, P=0.016), the 90-day good prognosis(mRS score≤2 points) rates were 41.6% and 0% respectively(P>0.05), in aspect of above indexes the Solumbra group was superior to the conventional stent thrombectomy group. Conclusion For endovascular recanalization of acute large cerebral artery occlusion stroke, Solumbra thrombectomy technique is safe and effective. The thrombectomy efficiency of Solumbra is higher than that of conventional stent-retriever thrombectomy. It is recommended that Solumbra technique should be used in some patients with circuitous pathways and high thrombus load.(J Intervent Radiol, 2019, 28: 515-520)
引文
[1]Berkhemer OA,Fransen PS,Beumer D,et al.A randomized trial of intraarterial treatment for acute ischemic stroke[J].NEngl J Med,2015,372:11-20.
[2]Campbell BC,Mitchell PJ,Kleinig TJ,et al.Endovascular therapy for ischemic stroke with perfusion-imaging selection[J].N Engl J Med,2015,372:1009-1018.
[3]Jovin TG,Chamorro A,Cobo E,et al.Thrombectomy within 8hours after symptom onset in ischemic stroke[J].N Engl J Med,2015,372:2296-2306.
[4]中华医学会神经病学分会,中华医学会神经病学分会神经血管介入协助组,急性缺血性脑卒中介入诊疗指南撰写组.中国急性缺血性脑卒中早期血管内介入诊疗指南[J].中华神经科杂志,2015,48:356-361.
[5]Delgado Almandoz JE,Kayan Y,Young ML,et al.Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either Solumbra or ADAPT techniques[J].J Neurointerv Surg,2016,8:1123-1128.
[6]中国卒中学会重症脑血管病分会专家撰写组.急性缺血性脑卒中血管内治疗术后监护与管理中国专家共识[J].中华医学杂志,2017,97:162-172.
[7]王洪生,刘圣,赵林波,等.Solitaire AB型支架取栓治疗急性大脑中动脉栓塞疗效分析[J].介入放射学杂志,2015,24:658-661.
[8]Zhou TF,Zhu LF,Li TX,et al.Application of retrievable Solitaire AB stents in the endovascular treatment of acute ischemic stroke[J].J Intervent Med,2018,1:77-81.
[9]Chueh JY,Kuehn AL,Puri AS,et al.Reduction in distal emboli with proximal flow control during mechanical thrombectomy:a quantitative in vitro study[J].Stroke,2013,44:1396-1401.
[10]张合亮,刘美利,孙刚,等.Solumbra血管内再通技术治疗急性大动脉闭塞性脑梗死[J].中华老年医学杂志,2018,37:148-153.
[11]Humphries W,Hoit D,Doss VT,et al.Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke[J].J Neurointerv Surg,2015,7:90-94.
[12]邢鹏飞,张永巍,杨鹏飞,等.Solumbra技术在急性大脑中动脉闭塞机械取栓中的应用[J].中华神经科杂志,2017,50:184-189.
[13]Nogueira RG,Lutsep HL,Gupta R,et al.Trevo versus Merci retrievers for thrombectomy revascularization of large vessel occlusion in acute ischaemic stroke(TREVO 2):a randomized trial[J].Lancet,2012,380:1231-1240.
[14]Zaidi SF,Aghaebrahim A,Urra X,et al.Final infarct volume is a stronger predictor of outcome than recanalization in patients with proximal middle cerebral artery occlusion treated with endovascular therapy[J].Stroke,2012,43:3238-3244.
[15]蒋文贤,齐立,唐永刚,等.颅内血栓抽吸系统联合可视性取栓支架治疗颅内大动脉急性梗死5例[J].介入放射学杂志,2017,26:971-974.
[16]Linfante I,Walker GR,Castonguay AC,et al.Predictors of mortality in acute ischemic stroke intervention:analysis of the North American Solitaire Acute Stroke registry[J].Stroke,2015,46:2305-2308.
[17]Lapergue B,Blanc R,Guedin P,et al.A direct aspiration,first pass technique(ADAPT)versus stent retrievers for acute stroke therapy:an observational comparative study[J].AJNR Am JNeuroradiol,2016,37:1860-1865.
[18]张合亮,郭再玉,刘美利,等.ADAPT技术在急性脑动脉闭塞血管内再通治疗中的应用[J].中华神经科杂志,2017,50:445-451.
[19]李子付,杨鹏飞,张永巍,等.Y形双支架取栓术治疗急性颈内动脉末端T形分叉闭塞[J].中华神经外科杂志,2016,32:706-709.
[20]Lee JS,Hong JM,Lee SJ,et al.The combined ues of mechanical thrombectomy devices is feasible for treating actue carotid terminus occlusion[J].Acta Neurochir(Wien),2013,155:635-641.
[21]周腾飞,朱良付,李天晓,等.补救性支架植入治疗急性缺血性脑卒中13例[J].介入放射学杂志,2017,26:1028-1033.
[2]Campbell BC,Mitchell PJ,Kleinig TJ,et al.Endovascular therapy for ischemic stroke with perfusion-imaging selection[J].N Engl J Med,2015,372:1009-1018.
[3]Jovin TG,Chamorro A,Cobo E,et al.Thrombectomy within 8hours after symptom onset in ischemic stroke[J].N Engl J Med,2015,372:2296-2306.
[4]中华医学会神经病学分会,中华医学会神经病学分会神经血管介入协助组,急性缺血性脑卒中介入诊疗指南撰写组.中国急性缺血性脑卒中早期血管内介入诊疗指南[J].中华神经科杂志,2015,48:356-361.
[5]Delgado Almandoz JE,Kayan Y,Young ML,et al.Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either Solumbra or ADAPT techniques[J].J Neurointerv Surg,2016,8:1123-1128.
[6]中国卒中学会重症脑血管病分会专家撰写组.急性缺血性脑卒中血管内治疗术后监护与管理中国专家共识[J].中华医学杂志,2017,97:162-172.
[7]王洪生,刘圣,赵林波,等.Solitaire AB型支架取栓治疗急性大脑中动脉栓塞疗效分析[J].介入放射学杂志,2015,24:658-661.
[8]Zhou TF,Zhu LF,Li TX,et al.Application of retrievable Solitaire AB stents in the endovascular treatment of acute ischemic stroke[J].J Intervent Med,2018,1:77-81.
[9]Chueh JY,Kuehn AL,Puri AS,et al.Reduction in distal emboli with proximal flow control during mechanical thrombectomy:a quantitative in vitro study[J].Stroke,2013,44:1396-1401.
[10]张合亮,刘美利,孙刚,等.Solumbra血管内再通技术治疗急性大动脉闭塞性脑梗死[J].中华老年医学杂志,2018,37:148-153.
[11]Humphries W,Hoit D,Doss VT,et al.Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke[J].J Neurointerv Surg,2015,7:90-94.
[12]邢鹏飞,张永巍,杨鹏飞,等.Solumbra技术在急性大脑中动脉闭塞机械取栓中的应用[J].中华神经科杂志,2017,50:184-189.
[13]Nogueira RG,Lutsep HL,Gupta R,et al.Trevo versus Merci retrievers for thrombectomy revascularization of large vessel occlusion in acute ischaemic stroke(TREVO 2):a randomized trial[J].Lancet,2012,380:1231-1240.
[14]Zaidi SF,Aghaebrahim A,Urra X,et al.Final infarct volume is a stronger predictor of outcome than recanalization in patients with proximal middle cerebral artery occlusion treated with endovascular therapy[J].Stroke,2012,43:3238-3244.
[15]蒋文贤,齐立,唐永刚,等.颅内血栓抽吸系统联合可视性取栓支架治疗颅内大动脉急性梗死5例[J].介入放射学杂志,2017,26:971-974.
[16]Linfante I,Walker GR,Castonguay AC,et al.Predictors of mortality in acute ischemic stroke intervention:analysis of the North American Solitaire Acute Stroke registry[J].Stroke,2015,46:2305-2308.
[17]Lapergue B,Blanc R,Guedin P,et al.A direct aspiration,first pass technique(ADAPT)versus stent retrievers for acute stroke therapy:an observational comparative study[J].AJNR Am JNeuroradiol,2016,37:1860-1865.
[18]张合亮,郭再玉,刘美利,等.ADAPT技术在急性脑动脉闭塞血管内再通治疗中的应用[J].中华神经科杂志,2017,50:445-451.
[19]李子付,杨鹏飞,张永巍,等.Y形双支架取栓术治疗急性颈内动脉末端T形分叉闭塞[J].中华神经外科杂志,2016,32:706-709.
[20]Lee JS,Hong JM,Lee SJ,et al.The combined ues of mechanical thrombectomy devices is feasible for treating actue carotid terminus occlusion[J].Acta Neurochir(Wien),2013,155:635-641.
[21]周腾飞,朱良付,李天晓,等.补救性支架植入治疗急性缺血性脑卒中13例[J].介入放射学杂志,2017,26:1028-1033.