Direct aspiration first pass technique (ADAPT) yog ib txoj kev thrombectomy uas siv lub nqus catheter kom ncaj qha aspirate thiab tshem tawm cov thrombus kom ua tiav vascular recanalization. Txoj kev no ntawm thrombectomy yog ceev, nyab xeeb, thiab siv tau. Txawm li cas los xij, hauv ADAPT, muaj ntau yam uas cuam tshuam rau qhov kev ntshaw. Kev xaiv ntawm kev txhawb nqa catheter, lub caliber ntawm lub nqus catheter, txoj kev aspiration, qhov chaw ntawm cov hlab ntsha occluded, thiab lwm yam yuav tag nrho cov cuam tshuam cov nyhuv ntawm aspiration thiab thrombectomy. Kab lus no yuav coj koj los nkag siab txog yam cuam tshuam rau ADAPT.
1. Proximal support catheter
Qhov kev txhawb nqa catheter ze ze yog lub hauv paus rau kev tsim kom muaj kev vam meej ntawm kev nkag mus rau ADAPT, muab kev txhawb nqa thiab kev ruaj ntseg rau tag nrho cov kev cia siab. Kev txhawb nqa catheters sib txawv tuaj yeem cuam tshuam qhov kev nkag mus ntawm qhov nruab nrab catheter thiab muaj peev xwm ncav cuag qhov kawg ntawm cov thrombus ze ntawm qhov chaw embolism, yog li cuam tshuam rau qhov kev ntshaw. Feem ntau siv cov kev txhawb nqa catheters muaj xws li ntev sheaths, balloon catheters lossis coj catheters. Thaum lub sijhawm ua haujlwm, nws yuav tsum tau ua tib zoo xav txog yam xws li tus neeg mob lub vascular anatomy thiab kev sib haum xeeb ntawm catheter los xaiv ib qho kev txhawb nqa catheter uas tsim nyog.
2. Aspiration catheter
Kev txhim kho ntawm kev ua haujlwm ntawm kev ua pa catheter tau txhawb txoj kev loj hlob ntawm ADAPT. Lub puab txoj kab uas hla ntawm lub aspiration catheter yog ib qho tseem ceeb uas cuam tshuam rau txoj kev vam meej ntawm aspiration. Qhov loj ntawm sab hauv txoj kab uas hla, qhov ntau dua qhov aspiration quab yuam generated, thiab ntau dua qhov kev vam meej ntawm aspiration thrombus tshem tawm. Qhov sib piv ntawm lub puab txoj kab uas hla ntawm lub aspiration catheter mus rau lub puab txoj kab uas hla ntawm lub proximal hlab ntsha ntawm lub embolization site kuj yog ib qho tseem ceeb cuam tshuam rau txoj kev vam meej ntawm aspiration. Qhov loj dua qhov sib piv, qhov siab dua qhov kev vam meej ntawm kev ntshaw. Lub bevel tsim ntawm aspiration catheter taub tuaj yeem txhim kho cov nyhuv aspiration.
3. Txoj kev Aspiration
Cov txheej txheem aspiration muaj xws li kev ua siab ntev nrog lub twj tso kua mis aspiration, cyclic siab aspiration nrog lub twj tso kua mis aspiration, thiab phau ntawv aspiration nrog 20 ~ 60ml syringe. Lub tshuab nqus tsev siab tsim los ntawm 60ml syringe yog siab dua li ntawm lub twj tso kua mis tsis siv neeg aspiration. Hauv kev ua haujlwm tiag tiag, phau ntawv aspiration kuj muaj kev nyab xeeb thiab ua haujlwm zoo dua, nrog rau cov nqi qis dua. Los ntawm kev sib piv, qhov clearance npaum li cas thiab aspiration efficiency ntawm cyclic siab aspiration nrog ib tug aspiration twj tso kua mis yog zoo dua li cov uas tsis tu ncua siab aspiration.
4. Occlusion site thiab kev sib cuag lub kaum sab xis ntawm thrombus thiab aspiration catheter
Qhov chaw ntawm vascular occlusion yog cuam tshuam nrog kev ua tiav ntawm aspiration recanalization. Cov kev tshawb fawb tau pom tias piv nrog rau sab hauv carotid siphon ntu occlusion lossis tandem lesions, cais nruab nrab cerebral artery occlusion yog ib qho txiaj ntsig zoo rau kev ua tiav rov qab los ntawm kev tshem tawm thrombus. Lub kaum sab xis ntawm lub aspiration catheter tip thiab thrombus kuj yog ib qho tseem ceeb cuam tshuam rau cov nyhuv aspiration. Qhov loj ntawm lub kaum sab xis, qhov zoo dua qhov aspiration nyhuv. Qhov laj thawj yog vim li cas qhov me me ntawm lub aspiration catheter thiab thrombus, qhov kev sib txhuam ntau dua, uas cuam tshuam cov thrombus los ntawm kev nqus mus rau hauv catheter.
5. Thrombus khoom
Thrombus muaj pes tsawg leeg cuam tshuam qhov kev vam meej ntawm kev ntshaw. Thrombus nplua nuj nyob rau hauv cov qe ntshav liab muaj kev vam meej ntau dua ntawm stent thrombectomy, thiab fibrin-nplua nuj thrombus muaj kev vam meej ntau dua ntawm ADAPT thrombectomy.
6. Cov yam ntxwv ntsig txog tus neeg mob
Tus neeg mob yau dua, lub sijhawm luv dua txij li pib mus rau kev phais, thiab qhov muaj peev xwm rov ua dua tom qab thrombus aspiration ntau dua. Cov tub ntxhais hluas cov neeg mob muaj cov kab mob zoo vascular, tsawg dua qhov mob hnyav thiab stenosis, thiab nws yooj yim los tsim kev nkag mus, thiab lub aspiration catheter tuaj yeem yooj yim mus txog qhov xav tau. Raws li lub sijhawm dhau mus, cov thrombus cuam tshuam nrog cov phab ntsa vascular thiab ua kom ruaj khov, ua rau muaj kev nyuaj siab.
Hauv cov ntsiab lus, qhov ua tiav ntawm ADAPT thrombectomy yog cuam tshuam los ntawm ntau yam. Ua ntej ua ADAPT, peb tuaj yeem txheeb xyuas cov xwm txheej cuam tshuam raws li tus neeg mob qhov xwm txheej tiag tiag thiab tsim ib txoj kev npaj tsim nyog rau tus neeg mob txhawm rau txhim kho qhov ua tiav ntawm ADAPT.