Gong Maofeng, Zhou Yangyi, He Xu, Chen Liang, Zhao Boxiang, Kong Jie, Su Haobo, Gu Jianping
Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu PR China.
Digit Health. 2022 Mar 18;8:20552076221084467. doi: 10.1177/20552076221084467. eCollection 2022 Jan-Dec.
Acute limb ischemia is one of the most common arterial emergencies. The data of mechanical revascularization using Solitaire AB device coupled with thromboaspiration for the treatment of popliteal and infrapopliteal acute limb ischemia are limited. The aim of this study was to review the preliminary safety and effectiveness.
We performed a single-center retrospective review of patients with popliteal and infrapopliteal acute limb ischemia treated with Solitaire AB device coupled with thromboaspiration from February 2019 to May 2020. Adjunctive balloon angioplasty was performed to correct coexisting atherosclerotic stenosis. Technical success was defined as successful deployment of the Solitaire AB device across the occlusive segment and successful retrieval without the use of adjunctive catheter-directed thrombolysis or balloon angioplasty. Clinical success was defined as the relief of symptoms related to acute limb ischemia. Follow-up outcomes were also reviewed.
There were 15 consecutive patients who underwent 16 Solitaire AB devices. Technical success was achieved in 11 (73.3%) patients. Of the unsuccessful patients, double-stent retrievers were employed in 1 (6.7%) patient. Two patients who encountered residual clots in distal small arteries underwent adjunctive catheter-directed thrombolysis. An adjunctive balloon angioplasty was required in 1 (6.7%) patient. All patients had notable acute limb ischemia symptom relief after the procedures. Clinical success was achieved in 14 (93.3%) patients. Besides one patient encountered minor amputation, the major amputation was prevented in all patients. No device-related complications or distal embolization events were recorded during the procedures. At the follow-up of 12 months, all surviving patients remained symptom-free, the patency was achieved in 12 (80%) patients and the limb salvage was 100%.
Preliminary outcomes suggest that mechanical revascularization using Solitaire AB device coupled with manual thromboaspiration appears to be a rapid, safe, and effective modality that appears to reduce the requirement for catheter-directed thrombolysis.
These findings may add a promising recanalization therapy for acute embolic occlusion of the acute limb ischemia secondary to popliteal and infrapopliteal arteries.
急性肢体缺血是最常见的动脉急症之一。使用Solitaire AB装置联合血栓抽吸术治疗腘动脉及腘以下急性肢体缺血的机械血管再通数据有限。本研究的目的是回顾其初步的安全性和有效性。
我们对2019年2月至2020年5月期间使用Solitaire AB装置联合血栓抽吸术治疗腘动脉及腘以下急性肢体缺血的患者进行了单中心回顾性研究。采用辅助球囊血管成形术纠正并存的动脉粥样硬化性狭窄。技术成功定义为Solitaire AB装置成功通过闭塞段并成功取出，且无需使用辅助导管定向溶栓或球囊血管成形术。临床成功定义为与急性肢体缺血相关的症状缓解。还对随访结果进行了回顾。
连续15例患者接受了16次Solitaire AB装置治疗。11例（73.3%）患者获得技术成功。在未成功的患者中，1例（6.7%）患者使用了双支架回收器。2例在远端小动脉中出现残留血栓的患者接受了辅助导管定向溶栓。1例（6.7%）患者需要进行辅助球囊血管成形术。所有患者术后急性肢体缺血症状均明显缓解。14例（93.3%）患者获得临床成功。除1例患者接受了小截肢外，所有患者均避免了大截肢。术中未记录到与装置相关的并发症或远端栓塞事件。在12个月的随访中，所有存活患者均无症状，12例（80%）患者实现血管通畅，肢体挽救率为100%。
初步结果表明，使用Solitaire AB装置联合手动血栓抽吸术进行机械血管再通似乎是一种快速、安全且有效的方式，似乎可减少导管定向溶栓的需求。
这些发现可能为腘动脉及腘以下动脉继发的急性肢体缺血急性栓塞性闭塞增添一种有前景的再通治疗方法。
