切换至 "中华医学电子期刊资源库"

中华神经创伤外科电子杂志 ›› 2024, Vol. 10 ›› Issue (02) : 112 -116. doi: 10.3877/cma.j.issn.2095-9141.2024.02.009

综述

急性前循环大血管闭塞机械取栓的研究进展
石豆豆1, 王新星1, 王向阳1, 刘震洋1, 曾淑娟1, 仝海波1,()   
  1. 1. 030032 太原,山西医科大学第三医院(山西白求恩医院、山西医学科学院、同济山西医院)神经外科
  • 收稿日期:2022-04-03 出版日期:2024-04-15
  • 通信作者: 仝海波

Research progress of mechanical thrombectomy in acute anterior circulation large vessel occlusion

Doudou Shi1, Xinxing Wang1, Xiangyang Wang1, Zhenyang Liu1, Shujuan Zeng1, Haibo Tong1,()   

  1. 1. Department of Neurosurgery, The Third Hospital of Shanxi Medical University (Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital), Taiyuan 030032, China
  • Received:2022-04-03 Published:2024-04-15
  • Corresponding author: Haibo Tong
  • Supported by:
    Scientific Research Project Plan of Shanxi Provincial Health Commission(2023054)
引用本文:

石豆豆, 王新星, 王向阳, 刘震洋, 曾淑娟, 仝海波. 急性前循环大血管闭塞机械取栓的研究进展[J]. 中华神经创伤外科电子杂志, 2024, 10(02): 112-116.

Doudou Shi, Xinxing Wang, Xiangyang Wang, Zhenyang Liu, Shujuan Zeng, Haibo Tong. Research progress of mechanical thrombectomy in acute anterior circulation large vessel occlusion[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2024, 10(02): 112-116.

急性缺血性卒中具有高发病率、高死亡率、高复发率等特点,其中大血管闭塞的占比逐年增高,且由于解剖等相关因素,前循环病变率可高达60%以上。急性前循环大血管闭塞病变原因复杂、病变形式多样,随着现代医学的发展,机械取栓以高再通率、高预后率等特点逐渐成为大血管闭塞再通的主要方式。本文围绕对近些年机械取栓方式的研究进展展开综述,以期为临床决策提供依据。

Acute ischemic stroke has the characteristics of high incidence, high mortality, high recurrence rate, etc. Among them, the proportion of large vessel occlusion is increasing year by year, and due to anatomical and other related factors, the rate of anterior circulation lesions can be as high as 60% or more. Acute anterior circulation large vessel occlusion has complex causes and diverse forms of lesions. With the development of modern medicine, mechanical thrombectomy has gradually become the dominant recanalization method for large vessel occlusion due to its high recanalization rate and high prognosis rate. This article provides a review of different mechanical thrombectomy methods in recent years to provide a basis for clinical decision-making.

[1]
《中国脑卒中防治报告》编写组.《中国脑卒中防治报告2020》概要[J].中国脑血管病杂志, 2022, 19(2): 136-144. DOI: 10.3969/j.issn.1672-5921.2022.02.011.
[2]
Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke[J]. N Engl J Med, 2015, 372(1): 11-20. DOI: 10.1056/NEJMoa1411587.
[3]
Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke[J]. N Engl J Med, 2015, 372(11): 1019-1030. DOI: 10.1056/NEJMoa1414905.
[4]
Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection[J]. N Engl J Med, 2015, 372(11): 1009-1018. DOI: 10.1056/NEJMoa1414792.
[5]
Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke[J]. N Engl J Med, 2015, 372(24): 2296-306. DOI: 10.1056/NEJMoa1503780.
[6]
Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke[J]. N Engl J Med, 2015, 372(24): 2285-95. DOI: 10.1056/NEJMoa1415061.
[7]
Grech R, Pullicino R, Thornton J, et al. An efficacy and safety comparison between different stentriever designs in acute ischaemic stroke: a systematic review and meta-analysis[J]. Clin Radiol, 2016, 71(1): 48-57. DOI: 10.1016/j.crad.2015.09.011.
[8]
Elgendy IY, Kumbhani DJ, Mahmoud A, et al. Mechanical thrombectomy for acute ischemic stroke: a meta-analysis of randomized trials[]. J Am Coll Cardiol, 2015, 66(22): 2498-2505. DOI: 10.1016/j.jacc.2015.09.070.
[9]
Chen CJ, Ding D, Starke RM, et al. Endovascular vs medical management of acute ischemic stroke[J]. Neurology, 2015, 85(22): 1980-90. DOI: 10.1212/WNL.0000000000002176.
[10]
曹洁,彭亚,宣井岗,等. Solitaire支架血管内治疗院内急性缺血性卒中[J].临床神经外科杂志, 2015, 12(6): 442-444, 448. DOI: 10.3969/j.issn.1672-7770.2015.06.011.
[11]
徐瑞,李兴. Solitaire AB支架取栓结合动脉内溶栓与单纯动脉内溶栓治疗急性脑动脉闭塞的比较[J].健康之路, 2015, 14(11): 33. DOI: 10.3969/j.issn.1671-8801.2015.11.032.
[12]
王洪生,刘圣,赵林波,等. Solitaire AB型支架取栓治疗急性大脑中动脉栓塞疗效分析[J].介入放射学杂志, 2015, 24(8): 658-661. DOI: 10.3969/j.issn.1008-794X.2015.08.002.
[13]
何俊,夏鹰,陈焕雄,等. Solitaire AB支架机械取栓治疗急性颅内动脉闭塞[J].中国临床神经外科杂志, 2015, 20(8): 466-468. DOI: 10.13798/j.issn.1009-153X.2015.08.007.
[14]
王彦平,温昌明,张保朝,等. TREVO支架取栓联合替罗非班在急性前循环大血管闭塞患者中的应用分析[J].中华神经医学杂志, 2021, 20(1): 29-34. DOI: 10.3760/cma.j.cn115354-20200920-00751.
[15]
高峰,徐安定.急性缺血性卒中血管内治疗中国指南2015[J].中国卒中杂志, 2015, 10(7): 590-606. DOI: 10.3969/j.issn.1673-5765.2015.07.011.
[16]
Saver JL, Jahan R, Levy EI, et al.SWIFT Trialists. SOLITAIRE™ with the intention for thrombectomy (SWIFT) trial: design of a randomized, controlled, multicenter study comparing the SOLITAIRE™ flow restoration device and the MERCI Retriever in acute ischaemic stroke[J]. Int J Stroke, 2014, 9(5): 658-668. DOI: 10.1111/j.1747-4949.2012.00856.x.
[17]
Turk AS, Frei D, Fiorella D, et al. ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy[J]. J Neurointerv Surg, 2014, 6(4): 260-264. DOI: 10.1136/neurintsurg-2014-011125.
[18]
Lapergue B, Blanc R, Gory B, et al. Effect of endovascular contact aspiration vs stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion: the ASTER randomized clinical trial[J]. JAMA, 2017, 318(5): 443-452. DOI: 10.1001/jama.2017.9644.
[19]
Turk AS 3rd, Siddiqui A, Fifi JT, et al. Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non-inferiority trial[J]. Lancet, 2019, 393(10175): 998-1008. DOI: 10.1016/S0140-6736(19)30297-1.
[20]
Primiani CT, Vicente AC, Brannick MT, et al. Direct aspiration versus stent retriever thrombectomy for acute stroke: a systematic review and meta-analysis in 9127 patients[J]. J Stroke Cerebrovasc Dis, 2019, 28(5): 1329-1337. DOI: 10.1016/j.jstrokecerebrovasdis.2019.01.034.
[21]
中国卒中学会,中国卒中学会神经介入分会,中华预防医学会卒中.急性缺血性卒中血管内治疗中国指南2018[J].中国卒中杂志, 2018, 13(7): 706-729. DOI: 10.3969/j.issn.1673-5765.2018.07.014.
[22]
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American heart association/American stroke association[J]. Stroke, 2019, 50(12): e344-e418. DOI: 10.1161/STR.0000000000000211.
[23]
吴小兵,杨旭森,洪宇.球囊扩张在急性缺血性卒中合并原位狭窄中的处理体会[J].中国临床神经外科杂志, 2021, 26(7): 544-545. DOI: 10.13798/j.issn.1009-153X.2021.07.016.
[24]
Chen W, Gong J, Song R, et al. Efficacy and safety of direct balloon angioplasty in the treatment of large atherosclerotic stroke[J]. Clin Neurol Neurosurg, 2021, 211: 107035. DOI: 10.1016/j.clineuro.2021.107035.
[25]
Feng MT, Zhang HJ, Zhang YX, et al. Stent angioplasty for acute intracranial atherosclerotic occlusion after failed thrombectomy: a single-institution series of 55 patients[J]. World Neurosurg, 2019, 130: e444-e448. DOI: 10.1016/j.wneu.2019.06.112.
[26]
Forbrig R, Lockau H, Flottmann F, et al. Intracranial rescue stent angioplasty after stent-retriever thrombectomy: multicenter experience[J]. Clin Neuroradiol, 2019, 29(3): 445-457. DOI: 10.1007/s00062-018-0690-4.
[27]
Yang D, Lin M, Wang S, et al. Primary angioplasty and stenting may be superior to thrombectomy for acute atherosclerotic large-artery occlusion[J]. Interv Neuroradiol, 2018, 24(4): 412-420. DOI: 10.1177/1591019918763380.
[28]
Lin CM, Wu YM, Chang CH, et al. The ANTRACK technique: employing a compliant balloon or stent retriever to advance a large-bore catheter to an occlusion during thrombectomy procedures in acute stroke patients[J]. Oper Neurosurg (Hagerstown), 2019, 16(6): 692-699. DOI: 10.1093/ons/opy202.
[29]
Massari F, Henninger N, Lozano JD, et al. ARTS (Aspiration-Retriever Technique for Stroke): initial clinical experience[J]. Interv Neuroradiol, 2016, 22(3): 325-332. DOI: 10.1177/1591019916632369.
[30]
刘沛,张磊,花伟龙,等.阶梯式血管内治疗策略在前循环急性颅内动脉粥样硬化性大血管闭塞患者中的应用效果[J].第二军医大学学报, 2022, 43(1): 60-64. DOI: 10.16781/j.0258-879x.2022.01.0060.
[31]
Wu Y, Wang J, Sun R, et al. A novel endovascular therapy strategy for acute ischemic stroke due to intracranial atherosclerosis-related large vessel occlusion: Stent-Pass-Aspiration-resCuE-Micowire-Angioplasty (SPACEMAN) technique[J]. Front Neurol, 2022, 13: 798542. DOI: 10.3389/fneur.2022.798542.
[1] 尚慧娟, 袁晓冬. 机械取栓术后应用依达拉奉右崁醇对急性缺血性脑卒中预后的改善[J]. 中华神经创伤外科电子杂志, 2023, 09(05): 295-301.
[2] 程飞, 杨辉, 周世玲, 赵航. 静脉溶栓后机械取栓桥接治疗急性大动脉闭塞脑梗死可行性研究[J]. 中华神经创伤外科电子杂志, 2023, 09(03): 149-153.
[3] 周章明, 余水, 梁张. 老年破裂前循环动脉瘤患者的急诊显微手术治疗研究[J]. 中华脑科疾病与康复杂志(电子版), 2024, 14(02): 106-111.
[4] 陈雪梅, 潘晓虎, 杨明刚, 刘邦勇, 曹月洲, 贾振宇, 赵林波, 刘圣. 不同基底动脉弯曲度对急性基底动脉闭塞患者取栓治疗的影响[J]. 中华脑科疾病与康复杂志(电子版), 2024, 14(02): 93-99.
[5] 陶栎, 张月辉, 王相明. 急性缺血性卒中院前急救体系的研究进展[J]. 中华脑科疾病与康复杂志(电子版), 2024, 14(01): 56-60.
[6] 陈科春, 吴秋义, 李建, 周寅, 徐周. 基于不同中性粒细胞与淋巴细胞比值探讨机械取栓术后首次CT征象与患者预后的关系[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(04): 215-221.
[7] 孙爱成, 曹月洲, 贾振宇, 赵林波, 施海彬, 刘圣. 低灌注强度比值对老年急性前循环大血管闭塞性脑卒中患者机械取栓治疗预后的影响[J]. 中华介入放射学电子杂志, 2024, 12(01): 15-21.
[8] 梁文雯, 李征, 万敏, 骆佳莹, 贾伟华. 急性缺血性卒中再灌注治疗后出血转化的研究进展[J]. 中华脑血管病杂志(电子版), 2024, 18(01): 71-80.
[9] 曹杨, 张士永. 伴大血管闭塞的急性前循环缺血性轻型卒中患者机械取栓治疗效果分析[J]. 中华脑血管病杂志(电子版), 2023, 17(06): 576-581.
[10] 辛伽伦, 袁兴运, 刘志勤, 师瑞, 蒋锋, 刘锋昌, 李伟旺, 张恒, 郭强, 何剑波, 姚力. 药物洗脱支架在急性大脑中动脉粥样硬化闭塞性卒中患者急诊血管成形术中的临床疗效[J]. 中华脑血管病杂志(电子版), 2023, 17(06): 539-544.
[11] 孙洪扬, 刘基, 龚字翔, 王广英, 宁召腾, 赵璇, 朱其义, 王贤军. 急性前循环大血管闭塞性轻型卒中血管内治疗的临床预后及手术时机选择[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 445-451.
[12] 袁兴运, 陈万红, 鱼丽萍, 姚力. 以Wallenberg综合征起病的椎动脉颅外段闭塞介入治疗探讨[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 394-399.
[13] 张文胜, 幸伟芳, 谢颖, 何锦照. 急性前循环大血管闭塞血管内治疗头颅CT高密度影的研究进展[J]. 中华脑血管病杂志(电子版), 2023, 17(02): 159-162.
[14] 曹杨, 张凯, 张士永. 低NIHSS评分伴大血管闭塞性急性缺血性卒中机械取栓治疗效果分析[J]. 中华脑血管病杂志(电子版), 2023, 17(02): 107-111.
[15] 张运, 裴月红, 傅瑜. 急性缺血性卒中静脉溶栓治疗进展[J]. 中华脑血管病杂志(电子版), 2023, 17(02): 83-88.
阅读次数
全文


摘要