Cov ntsiab lus ntawm Stent Retrieval
Lub hauv paus ntsiab lus ntawm niaj hnub stent retrieval yog tias nyob rau hauv cov kev taw qhia ntawm kev yees duab technology, tus kws kho mob kis tau ib tug kev taw qhia hlau los ntawm lub thrombus, ntxig ib tug microcatheter, thiab txhawb nqa stent retrieval mus rau hauv lub microcatheter, thiab ces tshem tawm lub catheter. Lub cim xeeb alloy stent yuav cia li tso tawm thiab qhib. Lub stent struts yog ua ke nrog cov thrombus kom embed lub thrombus mus rau hauv lub mesh qauv ntawm lub stent. Lub thrombus thiab stent raug tshem tawm ntawm lub cev ua ke, uas ua tiav cov haujlwm tshem tawm thrombus. Anouchska SA Autar thiab lwm tus tswvcuab tau ua micro-CT, histopathological thiab electron microscope scanning soj ntsuam ntawm stent thiab thrombus cov qauv coj los ntawm tag nrho lub cev ntawm tus neeg mob hauv MR CLEAN kev kawm sau npe, qhia txog cov qauv ntawm kev sib cuam tshuam ntawm stent struts thiab lub thrombus. Nws hom kev ua yog muab faib ua "mechanical type" thiab "adhesive type". Kev sib koom ua ke ntawm stent struts thiab thrombus yog lub hauv paus ntsiab lus ntawm kev ua ntawm tag nrho cov thrombus stent retriever.
Kev nce qib hauv Kev Tsim Kho Thrombectomy Stent Retriever
Siv cov khoom siv nickel-titanium alloy raws li tus neeg nqa khoom, cov kws tshawb fawb tuaj yeem siv cov ntsiab lus txheeb xyuas kom simulate qhov kev ua tau zoo ntawm thrombectomy stent retriever, radial txhawb zog ntawm stent retrieval, kev sib xyaw muaj peev xwm ntawm thrombus thiab stent, thiab kev sib txhuam quab yuam ntawm stent txav mus rau hauv cov hlab ntsha. Nrog rau qhov tshwm sim ntawm cov tsiaj tshiab ntawm cov hlab ntsha loj thrombosis occlusion, kev tshawb fawb thiab kev loj hlob ntawm thrombectomy stent retriever yog yooj yim dua thiab siv tau. Nrog rau kev txhim kho tas mus li ntawm kev ua haujlwm ntawm thrombectomy stent retriever, ib qho tshiab thrombectomy stent retrievers tau tshwm sim, xws li 3 hli txoj kab uas hla stent rau nruab nrab cov hlab ntsha (MeVO) rau thrombectomy, uas tuaj yeem xa tuaj rau hauv 0. 017 '' microcatheter system. Nws tuaj yeem txhim kho kev nyab xeeb ntawm M2 lossis M3. Ntev thrombectomy stent retrieval (40mm) tau tshaj tawm hauv cov ntaub ntawv uas tuaj yeem txhim kho thrombectomy efficiency.
Evolution ntawm Stent Retrieval Device Technology
Nrog rau kev nce qib ntawm kev tshawb fawb thiab thev naus laus zis, kev sib xyaw ua ke ntawm ntau yam khoom siv thiab khoom siv, thev naus laus zis ntawm thrombectomy stent retriever yog maj mam diversified. Cov tswv yim no muaj xws li kev xav ua ke nrog thrombectomy (Solumbra), stent retriever-pab vacuum locking aspiration (SAVE) cov txheej txheem, loj puab txoj kab uas hla lub zais pa catheter distal nkag catheter dual suction stent retriever raws li tus qauv (Badass) mus kom ze, aspiration thrombectomy technique (ARTS), proximal balloon thrombectomy (ASAP) kom thim cov stent mus rau hauv lub aspiration catheter los yog proximal balloon occlusion thiab ncaj thrombus aspiration thaum stent retrieval (PROTECT-PLUS), DAC catheter advancement thrombectomy stent (Advancing the DAC over the Stent Retriever, ADVANCE) technology. Cov txheej txheem thrombectomy no txhua tus koom nrog kev sib koom ua ke ntawm cov cuab yeej pabcuam xws li cov tshuaj aspiration catheters thiab balloon-guided catheters, thiab tag nrho cov qhia txog kev rov ua dua tshiab dua, ntau dua thawj zaug recanalization tus nqi, tsawg dua ntawm kev sim, thiab / lossis qis dua tus nqi ntawm distal embolism. Tsis tas li ntawd, muaj ob txoj kev stent rau kev nyuaj thrombectomy, xws li ob chav stent mechanical thrombectomy thiab cross-over double stent thrombectomy. Nrog rau kev hloov pauv ntawm cov khoom siv thiab qhov tshwm sim ntawm vascular sheaths nrog kev ua tau zoo thiab muaj zog passability, thrombectomy ntawm radial hlab ntsha nkag mus ua tau. Mechanical thrombectomy ntawm txoj kev transcarotid txhim kho qhov kev vam meej ntawm thrombectomy.
Kev txhim kho ntawm Stent Retrieval nyob rau hauv Acute Ischemic Stroke
Ua raws li kev tshawb fawb thiab kev tshuaj ntsuam xyuas ntawm tsib qhov kev sim tshuaj loj, nrog rau DAWN txoj kev tshawb fawb thiab kev tshawb fawb Deffuse3, nws tau pom tias thaum ntxov endovascular stent thrombectomy tuaj yeem txhim kho 90-hnub ua haujlwm prognosis ntawm cov neeg mob mob stroke. tsis muaj kev pheej hmoo ntawm intracranial hemorrhage thiab tuag. Cov pov thawj muaj zog no thawb txoj kev kho mob ntawm ischemic stroke mus rau lub sijhawm tshiab: los ntawm cov txheej txheem intravenous thrombolysis mus rau endovascular therapy raws li intravenous thrombolysis. Cov lus qhia ntawm ntau lub teb chaws tau ua raws sai, thiab cov lus qhia rau kev kho mob ntawm ischemic stroke hauv Tebchaws Meskas tau hloov kho. Tuam Tshoj Stroke Society tau teeb tsa cov kws tshaj lij hauv tebchaws no los tsim "Suav Cov Lus Qhia rau Kev Kho Mob Endovascular ntawm Acute Ischemic Stroke 2018". Raws li cov thev naus laus zis tshiab, stent retrieval tuaj yeem txuas ntxiv lub sijhawm kho rau cov neeg mob cerebral embolism mus txog 24 teev. Nws muaj cov ntaub ntawv pov thawj txaus thiab muaj txiaj ntsig zoo rau kev cuam tshuam ntawm cov hlab ntsha loj hauv cov hlab ntsha sab hauv xws li cov hlab ntsha hauv carotid thiab cov hlab ntsha hauv nruab nrab. Cov kws tshaj lij pom zoo tau tshaj tawm ua ntu zus hauv Tebchaws Europe thiab Tebchaws Meskas, pom zoo kom muaj kev cuam tshuam thrombectomy stent retriever raws li kev kho mob uas nyiam rau mob stroke ischemic.
Stent retrieval muaj qhov zoo ntawm kev rov ua kom sai sai, txo qis hemorrhagic transformation tus nqi thiab dav lub sij hawm qhov rais. Cov txiaj ntsig ntawm endovascular thrombectomy rau mob ischemic stroke nyob rau hauv lub anterior ncig tau raug lees paub. Rau cov neeg mob uas mob vertebral-basilar artery occlusion, endovascular stent retriever thrombectomy tau ua tiav qee qhov txiaj ntsig, tab sis txawm tias nws zoo dua li kev kho tshuaj, muaj qhov tsis muaj RCT Cov ntaub ntawv pov thawj kho mob tseem yuav tsum tau txiav txim siab. Cov lus qhia rau stent retriever yuav txuas ntxiv mus rau yav tom ntej, muaj txiaj ntsig zoo rau cov neeg mob AIS ntau dua, thiab yuav tsum dhau los ua cov kev taw qhia ntawm kev tshawb fawb neurointerventional.