Kitazawa Keiko, Ito Yasushi, Koyama Miyako, Ohara Hiroshi, Minagawa Makoto
Department of Neurosurgery, Shinrakuen Hospital, Niigata, Niigata, Japan.
Department of Neurology, Shinrakuen Hospital, Niigata, Niigata, Japan.
J Neuroendovasc Ther. 2021;15(5):332-338. doi: 10.5797/jnet.oa.2020-0153. Epub 2021 Mar 6.
The safety and efficacy of thrombectomy for small-artery occlusions is still controversial. In April 2019, Tron Fx, a stent retriever with an expansion diameter of 2 mm, became reimbursed by health insurance in Japan. We report on cases of thrombectomy for small-artery occlusions performed using this device in seven patients.
The subjects were seven patients who underwent thrombectomy between July 2019 and June 2020 using Tron Fx with 2 mm in diameter. We analyzed clinical results including recanalization and complications.
The mean age of the seven patients was 80.1 years, and the subjects included six men. The sites of occlusion were the middle cerebral artery M2 (n = 4), M4 (n = 1), anterior cerebral artery A2 (n = 1), and A3 (n = 1). One of the seven patients had an M2 occlusion that was formed during coil embolization for a ruptured cerebral aneurysm. In five cases, four cases were of primary occlusion and one case was of emboli into a new territory, treating with only Tron Fx 2 mm resulted in thrombolysis in cerebral infarction (TICI) 2b-3 in four cases. There was one case of grade 0, which was M4 occlusion. Finally, TICI 2b-3 were achieved in six of seven cases. No symptomatic intracranial hemorrhage occurred. Symptoms improved in five of six patients, excluding a vascular occlusion that occurred during surgery.
Tron Fx with 2 mm diameter can be used safely for small-artery occlusion. The introduction of Tron Fx with 2 mm diameter may contribute to expand indications for thrombectomy for small-artery occlusions.
小动脉闭塞性血栓切除术的安全性和有效性仍存在争议。2019年4月，扩张直径为2毫米的支架取栓器Tron Fx在日本被纳入医保报销范围。我们报告了7例使用该装置进行小动脉闭塞性血栓切除术的病例。
研究对象为2019年7月至2020年6月间使用直径2毫米的Tron Fx进行血栓切除术的7例患者。我们分析了包括再通和并发症在内的临床结果。
7例患者的平均年龄为80.1岁，其中男性6例。闭塞部位为大脑中动脉M2段（n = 4）、M4段（n = 1）、大脑前动脉A2段（n = 1）和A3段（n = 1）。7例患者中有1例M2段闭塞是在破裂脑动脉瘤的弹簧圈栓塞过程中形成的。在5例中，4例为原发性闭塞，1例为栓子进入新区域，仅使用2毫米的Tron Fx治疗，4例实现了脑梗死溶栓（TICI）2b - 3级。有1例0级，为M4段闭塞。最终，7例中有6例实现了TICI 2b - 3级。未发生有症状的颅内出血。6例患者中有5例症状改善，不包括手术期间发生的血管闭塞。
直径2毫米的Tron Fx可安全用于小动脉闭塞。直径2毫米的Tron Fx的引入可能有助于扩大小动脉闭塞性血栓切除术的适应证。
