急性颈内动脉起始部和颅内大血管串联闭塞的血管内治疗

doi:10.3969/j.issn.1672-6731.2020.05.008

摘要/Abstract

摘要：

目的探讨颈内动脉起始部闭塞串联颈内动脉颅内段和大脑中动脉闭塞致急性缺血性卒中患者血管内治疗的有效性和安全性。方法 2018年8-11月共5例颈内动脉起始部闭塞串联颈内动脉颅内段和大脑中动脉闭塞患者，均行颈内动脉起始部支架植入术，再行颅内动脉支架取栓术。术后即刻采用脑梗死溶栓血流分级（TICI）评价血管再通程度，术后3 d、90 d和1年采用改良Rankin量表（mRS）评价预后。结果 5例患者均顺利完成颈内动脉起始部支架植入术以及颈内动脉颅内段和大脑中动脉支架取栓术，手术成功率为5/5。术后即刻TICI分级3级2例、2b级2例、2a级1例，血管再通率为4/5，未发生颅内出血或动脉再闭塞，神经功能明显改善。术后90 d mRS评分0分2例，2分2例，3分1例。术后1年均预后良好（mRS评分0~1分）。结论颈内动脉起始部闭塞串联颈内动脉颅内段和大脑中动脉闭塞致急性缺血性卒中患者，急诊行颈内动脉起始部支架植入术并顺行颅内动脉支架取栓术安全、有效。

关键词: 动脉闭塞性疾病, 颈内动脉, 大脑中动脉, 支架, 脑血管造影术

Abstract:

Objective To evaluate the efficacy and safety of endovascular treatment (EVT) for acute tandem occlusion of proximal internal carotid artery (ICA) and intracranial large artery. Methods Five patients presented with acute tandem occlusion of proximal and intracranial ICA and middle cerebral artery (MCA) presented from August to November 2018 were included. Every patient was treated with proximal ICA stenting first and then intracranial artery sent thrombectomy. The result of revascularization was recorded with Thrombolysis in Cerebral Infarction (TICI) at the end of procedure. The outcome at 3 d, 90 d and one year postprocedure was evaluated with modified Rankin Scale (mRS). Results Proximal ICA stenting was successful and intracranial artery sent thrombectomy was performed in all patients. TICI grade 2b-3 was achieved in 4 patients and TICI grade 2a in one patient immidiately after surgery vascular recanalization rate was 4/5. There was no intracranial hemorrhage and more infarction. All patients had improved significantly. At 90 d after discharge, 2 patients had a mRS score 0, 2 patients had a mRS score 2, one patient had a mRS score 3. After one year, all patients remained a favorable clinical outcome (mRS score 0-1). Conclusions For patients presented with acute tandem occlusion of proximal ICA and intracranial large artery, antegrade recanalization with proximal ICA stenting and intracranial sent thrombectomy are safe and efficacious.

Key words: Arterial occlusive diseases, Carotid artery, internal, Middle cerebral artery, Stents, Cerebral angiography

尚彦国, 孙涛, 王轩, 高恺明, 佟小光. 急性颈内动脉起始部和颅内大血管串联闭塞的血管内治疗[J]. 中国现代神经疾病杂志, 2020, 20(5): 413-418.

SHANG Yan-guo, SUN Tao, WANG Xuan, GAO Kai-ming, TONG Xiao-guang. Endovascular treatment for acute tandem occlusion of proximal internal carotid artery and intracranial large artery[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(5): 413-418.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I5/413

参考文献

[1] Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H; American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Peripheral Vascular Disease, Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2013, 44:870-947.
[2] Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E, Brott T, Cohen G, Davis S, Donnan G, Grotta J, Howard G, Kaste M, Koga M, von Kummer R, Lansberg M, Lindley RI, Murray G, Olivot JM, Parsons M, Tilley B, Toni D, Toyoda K, Wahlgren N, Wardlaw J, Whiteley W, del Zoppo GJ, Baigent C, Sandercock P, Hacke W; Stroke Thrombolysis Trialists' Collaborative Group. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke:a Meta-analysis of individual patient data from randomised trials[J]. Lancet, 2014, 384:1929-1935.
[3] Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJ, van Walderveen MA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach HZ, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YB, van der Lugt A, van Oostenbrugge RJ, Majoie CB, Dippel DW; MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke[J]. N Engl J Med, 2015, 372:11-20.
[4] Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, Roy D, Jovin TG, Willinsky RA, Sapkota BL, Dowlatshahi D, Frei DF, Kamal NR, Montanera WJ, Poppe AY, Ryckborst KJ, Silver FL, Shuaib A, Tampieri D, Williams D, Bang OY, Baxter BW, Burns PA, Choe H, Heo JH, Holmstedt CA, Jankowitz B, Kelly M, Linares G, Mandzia JL, Shankar J, Sohn SI, Swartz RH, Barber PA, Coutts SB, Smith EE, Morrish WF, Weill A, Subramaniam S, Mitha AP, Wong JH, Lowerison MW, Sajobi TT, Hill MD; ESCAPE Trial Investigators. Randomized assessment of rapid endovascular treatment of ischemic stroke[J]. N Engl J Med, 2015, 372:1019-1030.
[5] Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, Yan B, Dowling RJ, Parsons MW, Oxley TJ, Wu TY, Brooks M, Simpson MA, Miteff F, Levi CR, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Priglinger M, Ang T, Scroop R, Barber PA, McGuinness B, Wijeratne T, Phan TG, Chong W, Chandra RV, Bladin CF, Badve M, Rice H, de Villiers L, Ma H, Desmond PM, Donnan GA, Davis SM; EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection[J]. N Engl J Med, 2015, 372:1009-1018.
[6] Chinese Medical Association, Chinese Society of Neurology, Neurovascular Intervention Cooperation Group, Writing Group of Guidelines for Interventional Diagnosis and Treatment of Acute Ischemic Stroke. Chinese guidelines for early intravascular intervention in patients with acute ischemic stroke[J]. Zhonghua Shen Jing Ke Za Zhi, 2015, 48:356-361.[中华医学会神经病学分会, 中华医学会神经病学分会神经血管介入协作组, 急性缺血性脑卒中介入诊疗指南撰写组. 中国急性缺血性脑卒中早期血管内介入诊疗指南[J]. 中华神经科杂志, 2015, 48:356-361.]
[7] Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL; American Heart Association Stroke Council. 2018 guidelines for the early management of patients with acute ischemic stroke a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2018, 49:E46-110.
[8] Rangel-Castilla L, Rajah GB, Shakir HJ, Shallwani H, Gandhi S, Davies JM, Snyder KV, Levy EI, Siddiqui AH. Management of acute ischemic stroke due to tandem occlusion:should endovascular recanalization of the extracranial or intracranial occlusive lesion be done first[J]? Neurosurg Focus, 2017, 42:E16.
[9] Sivan-Hoffmann R, Gory B, Armoiry X, Goyal M, Riva R, Labeyrie PE, Lukaszewicz AC, Lehot JJ, Derex L, Turjman F. Stent-retriever thrombectomy for acute anterior ischemic stroke with tandem occlusion:a systematic review and Meta-analysis[J]. Eur Radiol, 2017, 27:247-254.
[10] Lockau H, Liebig T, Henning T, Neuschmelting V, Stetefeld H, Kabbasch C, Dorn F. Mechanical thrombectomy in tandem occlusion:procedural considerations and clinical results[J]. Neuroradiology, 2015, 57:589-598.
[11] Gao F, Joyce Lo W, Sun X, Xu X, Miao Z. Combined use of stent angioplasty and mechanical thrombectomy for acute tandem internal carotid and middle cerebral artery occlusion[J]. Neuroradiol J, 2015, 28:316-321.
[12] Rho HW, Yoon WK, Kim HJ, Kim JH, Kwon TH. How to escape stentriever wedging in an open-cell carotid stent during mechanical thrombectomy for tandem cervical internal carotid artery and middle cerebral artery occlusion[J]. J Cerebrovasc Endovasc Neurosurg, 2017, 19:207-212.
[13] Slawski DE, Jumaa MA, Salahuddin H, Shawver J, Humayun MJ, Russell T, Seiwert A, Paolini D, Abbas J, Nazzal M, Tietjen GE, Espinosa-Morales A, Korsnack A, Zaidi SF. Emergent carotid endarterectomy versus stenting in acute stroke patients with tandem occlusion[J]. J Vasc Surg, 2018, 68:1047-1053.

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Endovascular treatment for acute tandem occlusion of proximal internal carotid artery and intracranial large artery

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Endovascular treatment for acute tandem occlusion of proximal internal carotid artery and intracranial large artery

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