摘要：

目的 探讨颅内大血管闭塞致急性缺血性卒中多模式血管内治疗的有效性和安全性。 方法 共16 例颅内大血管闭塞致急性缺血性卒中患者分别为左侧和右侧颈内动脉眼动脉段栓塞各2 例（4/16）、左侧大脑中动脉M1 段栓塞4 例（4/16）、左侧大脑中动脉M2 段栓塞1 例（1/16）、右侧大脑中动脉M1 段栓塞3 例（3/16）、左侧大脑前动脉与大脑中动脉分叉部栓塞3 例（3/16）、基底动脉中下部动脉粥样硬化血栓形成1 例（1/16），采用多模式血管内治疗（包括导管抽吸、机械取栓、动脉溶栓、球囊扩张术和支架植入术），术后即刻采用脑梗死溶栓血流分级（TICI）评价血管再通、入院时和术后21 d 美国国立卫生研究院卒中量表（NIHSS）评价神经功能、术后3 个月改良Rankin 量表（mRS）评价预后，并记录术后并发症发生情况。结果16 例患者中6 例（6/16）实现完全血管再通（TICI 分级3 级），8 例（8/16）实现部分血管再通（TICI 分级2 级），包括TICI 分级2a 级1 例（1/16）、TICI 分级2b 级7 例（7/16），2 例（2/16）未实现血管再通（TICI 分级0 ~ 1 级）。术后21 d NIHSS 评分低于入院时［12.50（6.75，19.25）分对18.00（13.25，21.50）分；Z = ? 2.287，P = 0.022］。术后3 个月mRS 评分1 分者2 例（2/16），2 分4 例（4/16），3 分5 例（5/16），4 分2 例（2/16），5 分2 例（2/16），6 分1 例（1/16）。术后并发肺部感染2 例（2/16），牙龈出血1 例（1/
16），原发梗死灶发生缺血性卒中出血性转化3 例（3/16），包括HI2 型2 例（2/16）、PH1 型1 例（1/16）。 结论 多模式血管内治疗方法如导管抽吸、机械取栓、动脉溶栓、球囊扩张术和支架植入术治疗颅内大血管闭塞致急性缺血性卒中安全、有效，可以明显改善患者生活质量。

关键词: 卒中, 脑缺血, 动脉闭塞性疾病, 脑动脉, 血栓切除术, 支架, 血栓溶解疗法

Abstract:

Objective  To investigate the effectiveness and safety of multi ? modal endovascular treatment on acute ischemic stroke caused by intracranial vascular occlusion.  Methods  Sixteen cases with acute ischemic stroke were studied, within which 4 cases were found respectively with left and right internal carotid artery (ICA) ophthalmic artery (OA) segment embolism (4/16), 4 cases were found occlusion at left M1 segment of middle cerebral artery (MCA, 4/16), one case was found occlusion at left M2 segment of MCA (1/16), 3 cases were found occlusion at right M1 segment of MCA (3/16), 3 cases were found occlusion at bifurcation of left anterior cerebral artery (ACA) and MCA (3/16), and one case was found atherosclerotic stenosis with thrombosis at middle and lower segment of basal artery (BA, 1/16). They underwent multi? modal endovascular treatment, including thrombus aspiration, mechanical thrombectomy, intra-arterial thrombolysis, balloon dilatation and stent implantation. The Thrombolysis in Cerebral Infarction (TICI) was used to evaluate the recanalization immediately after operation. National Institutes of Health Stroke Scale (NIHSS) was used to evaluate neurological function on admission and 21 d after operation, and modified Rankin Score (mRS) was used to evaluate the prognosis 3 months after treatment. Postoperative complications were recorded.  Results  Complete recanalization was found in 6 cases (6/16, TICI 3), 8 cases were found partial recanalization (TICI 2, 8/16), including TICI 2a in one case (1/16) and TICI 2b in 7 cases (7/16), and no recanalization was found in other 2 cases (TICI 0-1, 2/16). NIHSS score 21 d after operation was significantly lower than that on admission [12.50 (6.75, 19.25) score vs. 18.00 (13.25, 21.50) score; Z = ? 2.287, P = 0.022]. Followed?up for 3 months, mRS score was 1 in 2 cases (2/16), 2 in 4 cases (4/16), 3 in 5 cases (5/16), 4 in 2 cases (2/16), 5 in 2 cases (2/16) and 6 in one case (1/16). Postoperative complications included 2 cases of pulmonary infection (2/16), one case of gum bleeding (1/ 16), and 3 cases of hemorrhagic transformation (HT) of ischemic stroke (3/16), including 2 cases of hemorrhagic infarction (HI2, 2/16) and one case of parenchymal hematoma (PH1, 1/16).  Conclusions  Multi?modal endovascular treatment, including thrombus aspiration, mechanical hrombectomy, intra?arterial thrombolysis, balloon dilatation and stent implantation, is safe and effective for treating acute ischemic stroke, and can significantly improve the life quality of patients.

Key words: Stroke, Brain ischemia, Arterial occlusive diseases, Cerebral arteries, Thrombectomy, Stents, Thrombolytic therapy