CAJ | 학술논문

背景：为了避免机械取栓术中血栓脱落造成远端栓塞，作者以期运用微球囊临时隔截的方法来建立防止血栓脱落的保护装置。 　　目的：探讨采用微球囊临时阻断动脉血流并隔截栓塞段保护下行机械碎栓、吸栓联合溶栓治疗超急性脑梗死的安全性和可行性。 　　方法：Beagle犬10只在全身麻醉下经股动脉插管将微球囊导管送至优势侧椎动脉内并充盈球囊临时阻断血流，经微导管注入自体血栓建立椎动脉血栓栓塞模型，按治疗方法均分为2组，对照组采用单纯支架取栓，实验组采用微球囊导管临时阻断血流并隔截靶动脉后行机械碎栓吸栓联合药物溶栓。两组治疗后均行数字减影血管造影复查栓塞椎动脉再通状况；采用血栓性脑缺血血流分级进行血流动力学评估。造模前及取栓后12 h行磁共振弥散加权成像。建模后12 h行核磁共振成像检查后处死动物行病理检查，统计两组血管再通成功率及并发症。 　　结果与结论：10只beagle犬的优势侧椎动脉均成功出现血栓栓塞。对照组中2只犬椎动脉完全再通，3只犬椎动脉部分再通，其中1只犬椎-基底动脉与颅内动脉中可见多处小点状充盈缺损，颅内动脉显影差，对比剂返流，建模后12 h 磁共振弥散加权成像示左侧颞顶叶稍高信号影，病理检查示左侧大脑颞叶动脉腔内见血栓形成。实验组中5只犬椎动脉均完全再通，未见脑梗死。实验组血管再通率高于对照组(P<0.05)。结果证实，在急性脑动脉栓塞血管再通中采用微球囊导管临时阻断血流并隔截靶动脉保护下机械碎栓、吸栓联合尿激酶溶栓，可有效防止小栓子脱落栓塞远端动脉，安全有效。
배경：위료피면궤계취전술중혈전탈락조성원단전새，작자이기운용미구낭림시격절적방법래건립방지혈전탈락적보호장치。 　　목적：탐토채용미구낭림시조단동맥혈류병격절전새단보호하행궤계쇄전、흡전연합용전치료초급성뇌경사적안전성화가행성。 　　방법：Beagle견10지재전신마취하경고동맥삽관장미구낭도관송지우세측추동맥내병충영구낭림시조단혈류，경미도관주입자체혈전건립추동맥혈전전새모형，안치료방법균분위2조，대조조채용단순지가취전，실험조채용미구낭도관림시조단혈류병격절파동맥후행궤계쇄전흡전연합약물용전。량조치료후균행수자감영혈관조영복사전새추동맥재통상황；채용혈전성뇌결혈혈류분급진행혈류동역학평고。조모전급취전후12 h행자공진미산가권성상。건모후12 h행핵자공진성상검사후처사동물행병리검사，통계량조혈관재통성공솔급병발증。 　　결과여결론：10지beagle견적우세측추동맥균성공출현혈전전새。대조조중2지견추동맥완전재통，3지견추동맥부분재통，기중1지견추-기저동맥여로내동맥중가견다처소점상충영결손，로내동맥현영차，대비제반류，건모후12 h 자공진미산가권성상시좌측섭정협초고신호영，병리검사시좌측대뇌섭협동맥강내견혈전형성。실험조중5지견추동맥균완전재통，미견뇌경사。실험조혈관재통솔고우대조조(P<0.05)。결과증실，재급성뇌동맥전새혈관재통중채용미구낭도관림시조단혈류병격절파동맥보호하궤계쇄전、흡전연합뇨격매용전，가유효방지소전자탈락전새원단동맥，안전유효。
BACKGROUND:In order to avoid distal arterial embolism fol owing mechanical thrombectomy, micro-bal oon catheter temporary isolation is applied to prevent thrombus shedding. OBJECTIVE:To investigate the safety and feasibility of adopting the micro-bal oon catheter technique in treatment of the hyperacute cerebral infarction. The micro-bal oon catheter technique can temporarily block the artery blood flow and isolate the embolism location fol owing mechanical thrombectomy and aspiration combined with thrombolysis. METHODS:Ten beagle dogs were included in this study. Under general anesthesia, the micro-bal oon catheter was delivered to the dominant vertebral artery through the femoral artery in al the dogs and it was fil ed and temporarily blocked the blood flow. Then the autologous thrombus was injected through the micro-catheter into proximal vertebral artery to make a thrombosis model. Al the dogs were equal y divided into two groups according to the embolectomy method:control group (receiving pure stent embolectomy, n=5) and experimental group (n=5). The experiment group was disrupted and aspirated thrombus combined with the drug thrombolysis after temporarily blocking out the blood flow and isolating the target artery by micro-bal oon catheter technique. After treatment, two groups underwent digital subtraction angiography to review the vertebral artery recanalization after different embolectomy methods. The hemodynamic status was evaluated through the thrombolysis in cerebral ischemia grade. Al the dogs were scanned with magnetic resonance diffusion weighted imaging before modeling and at 12 hours after the thrombectomy. The animals were kil ed to perform pathological examination after magnetic resonance diffusion weighted imaging (12 hours after the thrombectomy). The vessel recanalization rates and complications were calculated in the two groups. RESULTS AND CONCLUSION:The thromboembolism model was successful y established in the dominant vertebral artery of al the 10 beagle dogs. In the control group, the vertebral arteries were completely successful recanalized in two dogs and were partly recanalized in three dogs, while the vertebral-basilar and intracranial arteries in one dog showed multiple smal punctate fil ing defects with poor intracranial arterial development and contrast agent reflux. At 12 hours after embolectomy, the magnetic resonance diffusion weighted imaging showed slightly high signal intensity at the left temporoparietal lobe and the pathologic examination suggested thrombosis in the cerebral artery lumen of the left temporal lobe. In the experimental group, the vertebral arteries in five dogs were completely recanalized without infarction. The revascularization rate in the experimental group was significantly higher than that in the control group (P<0.05). Experimental findings indicate that, the application of disruption and aspiration thrombus combined with the drug thrombolysis after temporarily blocking the blood flow and isolating the target artery by micro-bal oon catheter technique in treatment of hyperacute cerebral infarction, can effectively prevent the smal embolus exfoliating, which can cause distal embolization. Thus, the micro-bal oon catheter technique is a safe, effective and relatively inexpensive interventional embolectomy.