颈动脉夹层致急性大血管闭塞性缺血性卒中血管内治疗的单中心研究

doi:10.3969/j.issn.1672-6731.2020.05.009

摘要/Abstract

摘要：

目的探讨颈动脉夹层致急性大血管闭塞性缺血性卒中血管内治疗的有效性和安全性。方法 2018年7月至2019年7月共19例颈动脉夹层致急性大血管闭塞性缺血性卒中患者（包括颈内动脉夹层11例、椎动脉夹层8例），均行血管内治疗（包括抽吸取栓术、支架取栓术、球囊扩张术和支架植入术），采用改良脑梗死溶栓血流分级（mTICI）评价血管再通程度，改良Rankin量表（mRS）评价预后。结果术后15例mTICI分级3级（血管完全再通），4例mTICI分级2b级（血管部分再通）；1例脑疝形成致死亡，1例并发脑水肿，1例少量脑出血，1例蛛网膜下腔出血。17例预后良好（mRS评分≤ 2分），1例预后不良（mRS评分4分），1例死亡。结论颈动脉夹层致急性大血管闭塞性缺血性卒中患者经评估后采取血管内治疗，闭塞血管再通效果明显，临床预后良好。

关键词: 动脉闭塞性疾病, 颈内动脉夹层, 支架, 脑血管造影术

Abstract:

Objective To explore the efficacy and safety of endovascular treatment (EVT) for acute ischemic stroke with large vessel occlusion (AIS-LVO) caused by carotid artery dissection (CAD). Methods From July 2018 to July 2019, 19 patients with AIS-LVO caused by CAD, including 11 cases of internal carotid artery (ICA) dissection and 8 cases of vertebral artery (VA) dissection, were treated with EVT (including thrombus aspiration, stent thrombectomy, balloon dilatation and stent implantation). Modified Thrombdy in Cerebral Infarction (mTICI) was to evaluate vascular recanalization, modified Rankin Scale (mRS) was to evaluate the prognosis. Results The forward blood flow of 15 patients recovered to mTICI grade 3 (complete recanalization), and 4 patients recovered to mTICI grade 2b (partial recanalization). Patients with postoperative complications were:one case of death caused by cerebral hernia, one case of cerebral edema due to a large cerebral infarction, one case had a small amount of cerebral hemorrhage, one case of subarachnoid hemorrhage. Seventeen patients had good prognosis at discharge (mRS score ≤ 2), one case had a poor prognosis (mRS score 4), and one case died. Conclusions Patients with AIS-LVO caused by CAD were assessed and treated with EVT, and the effect of recanalization of occlusive vessels is obvious, and the clinical prognosis is good.

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

刘俊杰, 张智嵘, 张亮, 黎凯锋, 贺雄军, 刘亚杰. 颈动脉夹层致急性大血管闭塞性缺血性卒中血管内治疗的单中心研究[J]. 中国现代神经疾病杂志, 2020, 20(5): 419-426.

LIU Jun-jie, ZHANG Zhi-rong, ZHANG Liang, LI Kai-feng, HE Xiong-jun, LIU Ya-jie. Single-center study on endovascular treatment of acute ischemic stroke with large vessel occlusion caused by carotid artery dissection[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(5): 419-426.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I5/419

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2 颈动脉夹层致急性大血管闭塞性缺血性卒中血管内治疗的单中心研究

Single-center study on endovascular treatment of acute ischemic stroke with large vessel occlusion caused by carotid artery dissection

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2 颈动脉夹层致急性大血管闭塞性缺血性卒中血管内治疗的单中心研究

Single-center study on endovascular treatment of acute ischemic stroke with large vessel occlusion caused by carotid artery dissection

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