Ohshima Tomotaka, Kawaaguchi Reo, Matsuo Naoki, Miyachi Shigeru
Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan.
Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan.
Asian J Neurosurg. 2021 Mar 20;16(1):56-61. doi: 10.4103/ajns.AJNS_503_20. eCollection 2021 Jan-Mar.
For patients with acute ischemic stroke, various endovascular approaches have been reported with high recanalization rates and good clinical outcomes. However, the best technique for the first attempt at mechanical thrombectomy remains a matter of debate. In this study, we evaluated the efficacy of a modified version of a stent-retrieving into an aspiration catheter with a proximal balloon (ASAP) technique.
Modification 1: After stent deployment, the microcatheter was not removed immediately. Modification 2: After the withdrawal of the stent retriever into an aspirator and its removal from the entire system, we focused on the drainage of fluid into a pump. The aspirator was withdrawn slowly until the fluid appeared to be draining continuously into the pump. Before the removal of the aspirator, we performed angiography through the aspirator. We carried out a retrospective analysis of 30 consecutive patients with acute ischemic stroke caused by occlusion of the anterior circulation who were treated with the modified ASAP technique at our institution.
A thrombolysis in cerebral infarction score of 2B or 3 was achieved in 29/30 patients (96.7%). The average number of passes was 1.2 ± 0.5. The mean time from puncture to recanalization was 17.6 ± 6.84 min. Twenty-three (76.7%) patients achieved a modified Rankin Scale score of 0-2 at 3 months after the procedure.
We found that the modified ASAP technique yielded fast recanalization, minimal complications, and good clinical outcomes of mechanical thrombectomy in this case series.
对于急性缺血性卒中患者，已报道了多种血管内治疗方法，其再通率高且临床效果良好。然而，首次机械取栓的最佳技术仍存在争议。在本研究中，我们评估了一种改良的近端球囊辅助支架取栓器与抽吸导管相结合（ASAP）技术的疗效。
改良1：支架释放后，微导管不立即取出。改良2：将支架取栓器回撤至抽吸器并从整个系统中取出后，我们重点关注液体向泵内的引流。缓慢回撤抽吸器，直到液体似乎持续流入泵中。在取出抽吸器之前，通过抽吸器进行血管造影。我们对在我院接受改良ASAP技术治疗的30例连续的前循环闭塞所致急性缺血性卒中患者进行了回顾性分析。
29/30例患者（96.7%）达到脑梗死溶栓评分2B或3分。平均操作次数为1.2±0.5次。从穿刺到再通的平均时间为17.6±6.84分钟。23例（76.7%）患者在术后3个月时改良Rankin量表评分为0 - 2分。
在本病例系列中，我们发现改良的ASAP技术能实现快速再通、并发症极少且机械取栓的临床效果良好。
