症状性非急性大脑中动脉闭塞血管再通治疗研究

doi:10.3969/j.issn.1672-6731.2020.06.008

中国现代神经疾病杂志 ›› 2020, Vol. 20 ›› Issue (6): 512-518. doi: 10.3969/j.issn.1672-6731.2020.06.008

2 症状性非急性大脑中动脉闭塞血管再通治疗研究

李修珍¹, 闫文涛¹, 郭姗¹, 张振海¹, 张晓枫¹, 刘爱华², 刘加春¹

1. 100093 北京, 首都医科大学三博脑科医院神经介入科;
2. 100070 首都医科大学附属北京天坛医院神经介入中心国家神经系统疾病临床医学研究中心

收稿日期:2020-06-14 出版日期:2020-06-25 发布日期:2020-06-24
通讯作者: 刘加春,Email:jiachunliu2003@163.com
基金资助:
北京市科技计划项目（项目编号：Z171100000417046）

Clinical study on endovascular recanalization of symptomatic non-acute middle cerebral artery occlusion

LI Xiu-zhen¹, YAN Wen-tao¹, GUO Shan¹, ZHANG Zhen-hai¹, ZHANG Xiao-feng¹, LIU Ai-hua², LIU Jia-chun¹

1 Department of Neurological Intervention, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China;
2 Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University;China;National Clinical Research Center for Neurological Diseases, Beijing 100070, China

Received:2020-06-14 Online:2020-06-25 Published:2020-06-24
Supported by:
This study was supported by Beijing Science and Technology Plan Project (No. Z171100000417046).

摘要/Abstract

摘要：

目的总结症状性非急性大脑中动脉闭塞血管再通治疗的可行性、有效性和安全性。方法纳入2019年1-12月行血管再通治疗的8例非急性大脑中动脉闭塞患者，记录血管再通成功率、围手术期并发症、预后和支架内再狭窄情况。结果 8例患者中7例血管再通成功，1例失败。其中4例发生围手术期并发症，包括症状性颅内出血（2例）、短暂性脑缺血发作（1例）和支架内血栓形成（1例）。术后7和30 d改良Rankin量表评分0~2分6例、3分1例、4分1例。术后4个月1例发生支架内再狭窄。结论症状性非急性大脑中动脉闭塞患者，药物治疗效果欠佳时可考虑血管再通治疗，但该项技术复杂，围手术期并发症发生率较高。

关键词: 动脉闭塞性疾病, 大脑中动脉, 血管成形术, 支架, 手术中并发症

Abstract:

Objective To assess the feasibility, safety and short-term outcomes of angioplasty and stenting for patients with symptomatic non-acute middle cerebral artery occlusion (SNAMCAO). Methods Eight SNAMCAO patients who failed in medical treatment and underwent endovascular recanalization, were collected from January to December 2019. The success rate, perioperative complications, prognosis and stent restenosis were summarized. Results In 8 cases, 7 cases succeeded and one case failed. Four cases occurred perioperative complications, including symptomatic intracranial hemorrhage (2 cases), transient ischemic attact (1 case) and stent thrombosis (1 case). Seven to 13 d after operation the modifical Rankin Scale (mRS) 0-2 score were seen in 6 cases, 3 in one case and 4 in one case. Four months after operation one case occurred restenosis in the stent. Conclusions For patients with SNAMCAO, if medical treatment is not effective, endovascular recanalization can be considered, but the recanalization technique is complicated and the incidence of complications is still high. Therefore, the safety and necessity of endovascular recanalization need to be strictly evaluated.

Key words: Arterial occlusive diseases, Middle cerebral artery, Angioplasty, Stents, Intraoperative complications

李修珍, 闫文涛, 郭姗, 张振海, 张晓枫, 刘爱华, 刘加春. 症状性非急性大脑中动脉闭塞血管再通治疗研究[J]. 中国现代神经疾病杂志, 2020, 20(6): 512-518.

LI Xiu-zhen, YAN Wen-tao, GUO Shan, ZHANG Zhen-hai, ZHANG Xiao-feng, LIU Ai-hua, LIU Jia-chun. Clinical study on endovascular recanalization of symptomatic non-acute middle cerebral artery occlusion[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(6): 512-518.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I6/512

参考文献

[1] Wang Y, Zhao X, Liu L, Soo YO, Pu Y, Pan Y, Wang Y, Zou X, Leung WH, Cai Y, Bai Q, Wu Y, Wang C, Pan X, Luo B, Wong KS; CICAS Study Group. Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China:the Chinese Intracranial Atherosclerosis (CICAS) Study[J]. Stroke, 2014, 45:663-669.
[2] Shinohara Y, Minematsu K, Amano T, Ohashi Y. Modified Rankin scale with expanded guidance scheme and interview questionnaire:interrater agreement and reproducibility of assessment[J]. Cerebrovasc Dis, 2006, 21:271-278.
[3] Higashida RT, Furlan AJ, Roberts H, Tomsick T, Connors B, Barr J, Dillon W, Warach S, Broderick J, Tilley B, Sacks D. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke[J]. Stroke, 2003, 34:109-137.
[4] Samuels OB, Joseph GJ, Lynn MJ, Smith HA, Chimowitz MI. A standardized method for measuring intracranial arterial stenosis[J]. AJNR Am J Neuroradiol, 2000, 21:643-646.
[5] Pandey AS, Thompson BG, Gemmete JJ, Chaudhary N. Cerebral collateral circulation:integral todefining clinical outcome in acute cerebral ischeinia[J]. World Neurosurg, 2012, 77:240-242.
[6] Gao F, Xu AD. Chinese guidelines for endovascular treatment of acute ischemic stroke[J]. Zhongguo Zu Zhong Za Zhi, 2015, 10:590-606.[高峰, 徐安定. 急性缺血性卒中血管内治疗中国指南2015[J]. 中国卒中杂志, 2015, 10:590-606.]
[7] Chen QT. Clinical neurology[M]. Beijing:Beijing Science and Technology Publishing, 2000.[陈清棠. 临床神经病学[M]. 北京:北京科学技术出版社, 2000.]
[8] Ma N, Mo DP, Gao F, Miao ZR. Endovascular recanalization for chronic symptomatic middle cerebral artery total occlusion[J]. J Neurointerv Surg, 2013, 5:e15.
[9] Aghaebrahim A, Jovin T, Jadhav AP, Noorian A, Gupta R, Nogueira RG. Endovascular recanalization of complete subacute to chronic atherosclerotic occlusions of intracranial arteries[J]. J Neurointerv Surg, 2014, 6:645-648.
[10] Zheng M, Song Y, Zhang J, Zhao E, Sun L, Yin H, Zhang J, Wang W, Han J. Endovascular recanalization of non-acute symptomatic middle cerebral artery total occlusion and its short-term outcomes[J]. Front Neurol, 2019, 10:484-489.
[11] Lau AY, Wong EH, Wong A, Mok VC, Leung TW, Wong KL. Significance of good collateral compensation in symptomatic intracranial atheroscIerosis[J]. Cerebrovasc Dis, 2012, 33:517-524.
[12] Tomsick TA, Yeatts SD, Liebeskind DS, Carrozzella J, Foster L, Goyal M, Kummer R, Hill MD, Demchuk AM, Jovin T, Yan B, Zaidat OO, Schonewille W, Engelter S, Martin R, Khatri P, Spilker J, Palesch YY, Broderick JP; IMS Ⅲ Investigators. Endovascular revascularization results in IMS Ⅲ:intracranial ICA and M1 occlusions[J]. J Neurointerv Surg, 2015, 7:795-802.
[13] Teeuwen K, Adriaenssens T, Van den Branden BJ, Henriques JP, Van der Schaaf RJ, Koolen JJ, Vermeersch PH, Bosschaert MA, Tijssen JG, Suttorp MJ. A randomized multicenter comparison of hybrid sirolimus-eluting stents with bioresorbable polymer versus everolimus-eluting stents with durable polymer in total coronary occlusion:rationale and design of the primary stenting of occluded native coronary arteries Ⅳ study[J]. Trials, 2012, 13:240.
[14] Zhang K, Zhao TY, Xue JY, Zhang L, Li TX. Recanalization of middle cerebral artery occlusion in non acute phase:a case report and literature review[J/CD]. Zhonghua Wei Zhong Zheng Yi Xue Za Zhi (Dian Zi Ban), 2016, 9:262-265.[张坤, 赵同源,薛绛宇, 张磊, 李天晓. 非急性期大脑中动脉闭塞血管腔内再通一例及文献复习[J/CD]. 中华危重症医学杂志(电子版), 2016, 9:262-265.]

[1]	陈虹秀, 崔柳平, 陈松伟, 刘然, 李娜, 邢英琦. 经颅多普勒超声对脑血流自动调节的性别差异性研究[J]. 中国现代神经疾病杂志, 2023, 23(8): 758-764.
[2]	郭章宝, 许项前, 谌敏, 段振晖, 唐坤, 刘文华. 急性大脑中动脉M2段闭塞致缺血性卒中支架取栓术与直接抽吸取栓术对比分析[J]. 中国现代神经疾病杂志, 2022, 22(9): 810-816.
[3]	徐娜, 易婷玉, 王则托, 吴燕敏, 林定来, 陈文伙. 急性颈内动脉狭窄性串联病变颅内动脉机械取栓后急诊颈动脉支架成形术疗效分析[J]. 中国现代神经疾病杂志, 2022, 22(8): 729-737.
[4]	赵焱钢, 吕斌, 王君, 崔芳, 曹向宇, 李宝民. “橄榄头”技术在脑静脉窦狭窄支架植入术中的应用[J]. 中国现代神经疾病杂志, 2022, 22(6): 472-477.
[5]	曲典, 郝文思, 连芳, 胡舒缘, 谷亚钦, 段建钢. 恶性颅内高压诊治思考：一例报告[J]. 中国现代神经疾病杂志, 2022, 22(6): 500-506.
[6]	孙增峰, 尚彦国, 盛志国, 朱华雨, 佟小光. 基于球囊闭塞试验的脑血管侧支循环代偿能力评估及临床意义[J]. 中国现代神经疾病杂志, 2022, 22(5): 341-347.
[7]	何世豪, 刘子琪, 王嵘. 成人烟雾病脑血管搭桥术后短期神经功能和临床症状改善单中心研究[J]. 中国现代神经疾病杂志, 2022, 22(5): 348-352.
[8]	廖煜君, 何康民, 徐斌. 顺血流搭桥术与逆血流搭桥术对烟雾病患者桥血管血流通畅性的对比分析[J]. 中国现代神经疾病杂志, 2022, 22(5): 353-358.
[9]	王本琳, 孙杨, 李琪, 佟小光. 颞浅动脉-大脑中动脉搭桥术联合带蒂颞顶筋膜瓣贴敷术治疗烟雾病疗效分析[J]. 中国现代神经疾病杂志, 2022, 22(5): 368-373.
[10]	余冠东, 佟志勇, 刘源, 王刚, 张劲松, 初金刚. 颞浅动脉-大脑前动脉和颞浅动脉-大脑中动脉双搭桥术治疗烟雾病的对照研究[J]. 中国现代神经疾病杂志, 2021, 21(7): 537-546.
[11]	孙杨, 王本琳, 李琪, 佟小光. 低流量血管搭桥术治疗慢性症状性大脑中动脉闭塞疗效分析[J]. 中国现代神经疾病杂志, 2021, 21(7): 547-552.
[12]	韩庆东, 黄亚波. 颅内外血管搭桥术在颅内大型和巨大型血栓性动脉瘤中的应用[J]. 中国现代神经疾病杂志, 2021, 21(7): 562-568.
[13]	贾强, 范一木. 颅内血泡样动脉瘤治疗进展[J]. 中国现代神经疾病杂志, 2021, 21(4): 329-334.
[14]	王文鑫, 王革生, 薛哲, 孙正辉, 马林. 单侧症状性颈动脉狭窄颈动脉内膜切除术或颈动脉支架成形术早期脑血流动力学变化及围手术期事件[J]. 中国现代神经疾病杂志, 2021, 21(12): 1103-1110.
[15]	陈平, 刘嘉琳, 林嘉星, 关敏, 乔宏宇, 黄立安. 症状性大脑中动脉粥样硬化性狭窄干预策略[J]. 中国现代神经疾病杂志, 2021, 21(1): 41-45.

选择文件类型/文献管理软件名称

选择包含的内容

2 症状性非急性大脑中动脉闭塞血管再通治疗研究

Clinical study on endovascular recanalization of symptomatic non-acute middle cerebral artery occlusion

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

2 症状性非急性大脑中动脉闭塞血管再通治疗研究

Clinical study on endovascular recanalization of symptomatic non-acute middle cerebral artery occlusion

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价