摘要目的 探讨直接抽吸一次性取栓(ADAPT)技术治疗急性动脉粥样硬化性颅内大血管闭塞的疗效和安全性.方法 对河南省人民医院脑血管病医院自2018年3月至2019年3月采用ADAPT技术治疗的24例急性动脉粥样硬化性颅内大血管闭塞患者(ADAPT组),术中采用改良脑梗死溶栓(mTICI)分级评估血管再通情况,再通失败后再予补救性治疗措施,术后3个月根据改良Rankin量表评分(mRS)评估预后,并与同期采用Solitaire支架联合Penumbra抽吸导管取栓(Solumbra)技术治疗的48例患者(Solumbra组)比较疗效和安全性的差异.结果 与Solumbra组比较,ADAPT组患者股动脉穿刺至复流时间较短,差异有统计学意义(P<0.05).Solumbra组和ADAPT组首次血管再通率分别为25.00％、16.67％,最终血管再通率分别为83.33％、75.00％,差异均无统计学意义(P>0.05).术后3个月Solumbra组和ADAPT组间预后良好者比例以及围手术期症状性颅内出血发生率、死亡率差异均无统计学意义(P>0.05).结论 对于急性动脉粥样硬化性颅内大血管闭塞患者,ADAPT技术的疗效和安全性与Solumbra技术相当.

abstractsObjective To investigate the efficacy and safety of a direct aspiration first-pass thrombectomy (ADAPT) technique in treating acute atherosclerotic intracranial large vessel occlusion. MethodsSeventy-two patients with acute atherosclerotic intracranial large vessel occlusion underwent endovascular treatment in our hospital from March 2018 to March 2019 were chosen in our study; ADAPT technique was used in 24 patients, and Solitaire stent combined with penumbra suction catheter extraction (Solumbra) technique was used in 48 patients. Remedial measures were adopted after the failure of recanalization. Modified intraoperative cerebral infarction thrombolysis grading was used for vascular recanalization evaluation. The prognoses of the patients were determined according to modified Rankin scale (mRS) scores 3 months after operation, and the efficacy and safety of the patients in the two groups were compared.ResultsAs compared with patients in the Solumbra group, patients in the ADAPT group had statistically shorter time from femoral artery puncture to reflow (P<0.05). The first-time recanalization rates of patients in Solumbra group and ADAPT group were 25.0％ and 16.67％, without statistically significant difference (P>0.05). The final recanalization rates of patients in Solumbra group and ADAPT group were 83.33％ and 75.00％, without statistically significant difference (P>0.05). There was no significant difference in proportion of patients with good prognosis, incidence of perioperative symptomatic intracranial hemorrhage and mortality between the two groups (P>0.05). ConclusionFor patients with acute atherosclerotic intracranial large vessel occlusion, endovascular treatment with ADAPT technique is comparable with Solumbra technique.