摘要目的 比较分析Solumbra技术与单纯支架机械取栓在急性大脑中动脉闭塞机械取栓术中对血管再通成效及患者预后的影响.方法 回顾性连续纳入52例2013年9月至2015年12月在长海医院脑血管病中心收治的因急性大脑中动脉闭塞(M1/M2段)行介入取栓治疗的病例,根据中间导管应用与否分为研究组(应用中间导管的Solumbra技术组)和对照组(无中间导管的单纯支架机械取栓组).研究组共纳入21例(男性13例),对照组共纳入31例(男性19例).评价两组的血管再通率、并发症发生率、手术操作时间及术后90 d时的良好预后情况.结果 两组病例资料的基线水平略有差异,研究组年龄显著高于对照组(t=2.806,P<0.05),但发病到穿刺时间显著短于对照组(t=-2.603,P<0.05),其余基线资料(性别、是否静脉溶栓、闭塞部位、NIHSS评分、侧支循环代偿评分系统评分等)差异无统计学意义.研究组一次取栓成功的比例达57.1%,显著高于对照组(29.0%)(χ2=4.109,P<0.05),取栓次数也显著低于对照组(分别为1、2次)(Z=2.455,P<0.05),从而显著缩短了从股动脉穿刺到满意再灌注的时间[分别为(68.38±41.72)、(93.36±41.03)min,t=-2.139,P<0.05].研究组血管成功再通达改良脑梗死溶栓分级2b/3级的比例显著高于对照组(分别为90.5%、77.4%;χ2=10.496,P<0.05).研究组Navien中间导管均可以到达取栓支架近端辅助抽吸,远端血管栓塞和异位栓塞发生率较对照组明显减少(分别为9.5%、41.9%;χ2=4.926,P<0.05);两组颅内出血和症状性颅内出血等并发症发生率差异无统计学意义(均P>0.05).对所有患者进行电话或门诊临床随访评估发现,研究组的90 d良好临床预后(改良Rankin量表评分≤2分)比例显著高于对照组(分别为71.4%、41.9%;χ2=4.382,P<0.05).结论 本研究结果初步表明,与单纯支架机械取栓相比,Solumbra技术能有效提高急性大脑中动脉闭塞机械取栓的效率和成功率,降低远端栓塞或异位栓塞的比例,从而改善患者临床预后.研究结果仍需要进一步大样本数据验证.

abstractsObjective To compare the efficacy and prognosis of Solumbra technique and simple stent mechanical thrombectomy for emergency revascularization in treating acute middle cerebral artery occlusion.Methods A total of 52 consecutive patients with acute middle cerebral artery occlusion admitted to the Cerebrovascular Disease Center , Changhai Hospital from September 2013 to December 2015 were enrolled retrospectively.According to whether using intermediate catheter , they were divided into study group and control group.There were 21 patients (male 13 cases) in the study group, using Solumbra technique with intermediate catheter .And another 31 patients ( male 19 cases ) were in the control group without using intermediate catheter .The vascular recanalization rate , complication rate , operation time and good prognosis at 90 d after operation were evaluated in the two groups .Results The patients′age was elder and the onset-to-puncture time was shorter in the study group than those in the control group ( t=2.806, t=-2.603, P<0.05).But other baseline characters were consistent on both groups , including sex, with or without intravenous thrombolysis , occluded arteries , NIHSS score and American Society of Interventional and Therapeutic Neuroradiology Collateral Grading System ( ACG ) score ( all P>0.05 ) . Comparing with the control group , the rate of first-pass thrombectomy achieving successful recanalization was higher and the average thrombectomy time was lower in the study group , which were 57.1% vs 29.0%(χ2 =4.109, P<0.05 ) and 1 vs 2 ( Z=2.455, P<0.05 ) .So the puncture-to-reperfusion time was significantly shorter in the study group , ( 68.38 ±41.72 ) minutes vs ( 93.36 ±41.03 ) minutes ( t =-2.139,P<0.05).The final rate of successful reperfusion (modified thrombolysis in cerebral infarction 2b/3) in the study group was higher, 90.5% vs 77.4% (χ2 =10.496, P<0.05).The secondary embolization on the distal and ectopic arteries was decreased in the study group because of the Navien intermedia catheter continually aspirating in the proximal of the stent , 9.5% vs 41.9% (χ2 =4.926, P<0.05).There were no statistically significant differences in the incidence of intracranial hemorrhage and symptomatic intracranial hemorrhage (both P>0.05).All the patients were followed up by telephone call or outpatient visit and the good outcome (modified Rankin Scale (mRS) score ≤2) at 90 days in the study group was better obviously , 71.4%vs 41.9% (χ2 =4.382, P<0.05).Conclusions In the emergency revascularization of acute middle cerebral artery occlusion , the Solumbra technique is better at increasing the efficacy of thrombectomy and succession , reducing the incidence of secondary distal and ectopic embolization, and improving the good outcome ( mRS score ≤2) at 90 days compared with simple stent mechanical thrombectomy .The results still need to be proved by large sample data in the future .