在急性缺血性脑卒中患者的血管内治疗中，于动脉闭塞期间提前使用含氧血液再灌注。
Bringing forward reperfusion with oxygenated blood perfusion beyond arterial occlusion during endovascular procedures in patients with acute ischemic stroke.
机构信息
Hospital Vall d'Hebron, Barcelona, Spain.
出版信息
AJNR Am J Neuroradiol. 2010 Nov;31(10):1899-902. doi: 10.3174/ajnr.A2221. Epub 2010 Aug 26.
BACKGROUND AND PURPOSE
High recanalization rates achieved with endovascular procedures are not always followed by the expected clinical improvement. These time-consuming procedures imply a delayed reperfusion despite the capacity of earlier intravascular microcatheter bypass to the ischemic tissue beyond the clot. We aimed to explore the safety and feasibility of MOB beyond the clot.
MATERIALS AND METHODS
We studied patients with stroke undergoing endovascular procedures. The timing of procedural steps was recorded. We then explored the safety and feasibility of repeated femoral artery MOB injections beyond the occlusion every time the clot was crossed in 17 patients. Pre- and postocclusion flow was continuously monitored with TCD.
RESULTS
We studied 60 patients (mean age, 70 ± 11 years; median NIHSS score, 20; IR, 18-21). Of them, 33 (55%) received IV-tPA before the endovascular procedure. The following arteries were occluded: the MCA (63.3%, n = 38) and the ICA (36.6%, n = 22). The TSO to arterial puncture was 193 ± 77 minutes. The occluding clot was successfully crossed with the microcatheter in 46 patients (76.6%; mean TSO, 228 ± 82 minutes). Recanalization was achieved in 44 patients (73.2%; mean TSO, 328 ± 144 minutes). Repeated MOB injections were performed in 17 patients. Patients with/without MOB presented with similar baseline characteristics. The median number of MOB injections was 2 (IR, 2-3), and the median injected blood volume was 40 mL (IR, 27.5-50). The mean time from first MOB to arterial recanalization was 136 ± 86 minutes. During MOB, a nonpulsatile flow appeared in previously nonvisible distal branches on TCD.
CONCLUSIONS
In this small series, oxygenated blood delivered through a microcatheter positioned distal to the site of occlusion was feasible and safe. Until final recanalization is achieved, MOB injections may generate intermittent reperfusion for up to 2 hours.
背景与目的
尽管血管内微导管旁路能够将缺血组织与血栓部位以外的区域进行早期连接，但血管内治疗后实现的高再通率并不总是伴随着预期的临床改善。这些耗时的操作程序意味着即使在血栓部位被越过之后，也会出现延迟再灌注的情况。我们旨在探索血栓部位以外的微导管氧合（MOB）的安全性和可行性。
材料与方法
我们研究了接受血管内治疗的卒中患者。记录了操作步骤的时间。然后，我们在 17 名患者中探索了每次越过血栓部位时，在股动脉内重复进行 MOB 注射的安全性和可行性，此时血栓部位以外的区域发生了闭塞。使用 TCD 连续监测闭塞前和闭塞后的血流情况。
结果
我们研究了 60 名患者（平均年龄 70 ± 11 岁；中位数 NIHSS 评分 20；IR 为 18-21）。其中 33 名（55%）患者在血管内治疗前接受了 IV-tPA 治疗。闭塞的动脉包括 MCA（63.3%，n = 38）和 ICA（36.6%，n = 22）。从 TSO 到动脉穿刺的时间为 193 ± 77 分钟。微导管成功穿过闭塞的血栓部位 46 名患者（76.6%；平均 TSO 为 228 ± 82 分钟）。44 名患者（73.2%；平均 TSO 为 328 ± 144 分钟）实现了再通。17 名患者进行了重复 MOB 注射。有/无 MOB 注射的患者具有相似的基线特征。MOB 注射的中位数次数为 2 次（IR 为 2-3），注入的血液量中位数为 40 mL（IR 为 27.5-50）。从第一次 MOB 到动脉再通的平均时间为 136 ± 86 分钟。在 MOB 期间，TCD 上先前不可见的远端分支出现了非搏动性血流。
结论
在这个小系列中，将微导管置于闭塞部位远端输送含氧血液是可行且安全的。在最终再通实现之前，MOB 注射可能会产生长达 2 小时的间歇性再灌注。
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