Nemoto Mio, Ohshima Tomotaka, Yokota Mao, Ato Fuminori, Kawaguchi Reo, Matsuo Naoki, Saito Kiyoshi, Miyachi Shigeru
Department of Neurological Surgery, Aichi Medical University, Nagakute, Aichi, Japan.
Department of Neurosurgery, Fukushima Medical University, Fukushima, Fukushima, Japan.
J Neuroendovasc Ther. 2021;15(12):818-822. doi: 10.5797/jnet.tn.2020-0174. Epub 2021 Apr 1.
Accurately determining the clot position is highly important for immediate recanalization when endovascular mechanical thrombectomy is performed using a stent retriever and aspiration catheter. We describe a new method that facilitates the precise identification of the clot position called pull the trigger sign (PTS).
Selective angiography was performed through a 0.027-inch microcatheter that penetrated the clot into the distal lumen. Although the contrast media highlighted the occluded artery, it often stagnated in the distal artery. It was washed away at a certain point when a stent clot retriever was deployed over the potential clot site. We hypothesized that this point represented the exact position of the clot's proximal end and used analyses to assess this hypothesis. Briefly, a circulation-enabled silicone vascular model in which colored water was used to simulate stagnation beyond a fake clot was developed and utilized to investigate PTS six times. The rate of identifying PTS in the vascular model was 100%. As hypothesized, stagnant fluid was washed away when the deployed stent reached the clot's proximal position. The clinical efficacy of PTS was also confirmed.
PTS was useful in revealing the precise position of clot's proximal end, which enabled safer contact aspiration when using an aspiration catheter. Thus, PTS led to a higher success rate and faster recanalization in the first attempt than conventional methods.
在使用支架取栓器和抽吸导管进行血管内机械取栓时，准确确定血栓位置对于立即再通至关重要。我们描述了一种有助于精确识别血栓位置的新方法，称为触发征（PTS）。
通过一根0.027英寸的微导管进行选择性血管造影，该微导管穿过血栓进入远端管腔。尽管造影剂突出显示了闭塞的动脉，但它通常会在远端动脉中停滞。当在潜在的血栓部位上方部署支架取栓器时，造影剂在某一点被冲走。我们假设这一点代表血栓近端的精确位置，并进行了分析以评估这一假设。简而言之，开发了一种启用循环的硅胶血管模型，其中使用有色水模拟假血栓后方的停滞情况，并利用该模型对触发征进行了6次研究。在血管模型中识别触发征的成功率为100%。正如所假设的，当展开的支架到达血栓近端位置时，停滞的液体被冲走。触发征的临床疗效也得到了证实。
触发征有助于揭示血栓近端的精确位置，这使得在使用抽吸导管时进行更安全的接触抽吸成为可能。因此，与传统方法相比，触发征在首次尝试时导致更高的成功率和更快的再通。
