Goto Shunsaku, Ohshima Tomotaka, Ishikawa Kojiro, Yamamoto Taiki, Shimato Shinji, Nishizawa Toshihisa, Kato Kyozo
Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
World Neurosurg. 2018 Jan;109:e468-e475. doi: 10.1016/j.wneu.2017.10.004. Epub 2017 Oct 13.
The best technique for the first attempt at mechanical thrombectomy for acute ischemic stroke is a still matter of debate. In this study, we evaluate the efficacy of a stent-retrieving into an aspiration catheter with proximal balloon (ASAP) technique that uses a series of thrombus extraction by withdrawing the stent retriever into the aspiration catheter and continuous aspiration from the aspiration catheter at the first attempt.
We performed a retrospective analysis of 42 consecutive patients with acute ischemic stroke caused by occlusions in the anterior circulation who were treated with the ASAP technique at our institution. Preoperative patient characteristic, including age, thrombus location, Alberta Stroke Program Early CT Score, National Institutions of Health Stroke Scale, and time from onset to puncture; postoperative Thrombolysis in Cerebral Infarction score; modified Rankin Scale score after 3 months; time from puncture to recanalization; the number of passes to achieve recanalization; and procedural complications, including intracranial hemorrhage, embolization to new territory, and distal embolization, were assessed.
A Thrombolysis in Cerebral Infarction score of 2B or 3 was achieved in 40/42 patients (95.2%). Average time from puncture to the final recanalization was 21.5 minutes. Recanalization was achieved in a single attempt in 31 patients (77.5%). Embolization to new territory was observed in only 2 patients (4.8%); no patient developed distal embolization or intracranial hemorrhage including asymptomatic subarachnoid hemorrhage. Thirty-two patients (76.2%) achieved modified Rankin Scale scores of 0-2 at 3 months postoperatively.
Our ASAP technique showed fast recanalization, minimal complications, and good clinical outcomes in this case series.
急性缺血性卒中首次机械取栓的最佳技术仍是一个有争议的问题。在本研究中，我们评估了一种带有近端球囊的支架回收至抽吸导管（ASAP）技术的疗效，该技术在首次尝试时通过将支架回收器撤回抽吸导管并从抽吸导管持续抽吸来进行一系列血栓抽吸。
我们对在本机构接受ASAP技术治疗的42例因前循环闭塞导致急性缺血性卒中的连续患者进行了回顾性分析。评估术前患者特征，包括年龄、血栓位置、阿尔伯塔卒中项目早期CT评分、美国国立卫生研究院卒中量表以及从发病到穿刺的时间；术后脑梗死溶栓评分；3个月后的改良Rankin量表评分；从穿刺到再通的时间；实现再通的操作次数；以及手术并发症，包括颅内出血、栓塞到新区域和远端栓塞。
42例患者中有40例（95.2%）达到脑梗死溶栓评分2B或3分。从穿刺到最终再通的平均时间为21.5分钟。31例患者（77.5%）单次尝试即实现再通。仅2例患者（4.8%）观察到栓塞到新区域；没有患者发生远端栓塞或颅内出血，包括无症状蛛网膜下腔出血。32例患者（76.2%）术后3个月改良Rankin量表评分为0 - 2分。
在本病例系列中，我们的ASAP技术显示出快速再通、并发症极少且临床结局良好。
