前循环串联闭塞致急性缺血性卒中血管内治疗

doi:10.3969/j.issn.1672-6731.2020.11.011

摘要/Abstract

摘要：

目的探讨远端机械取栓结合同期颈动脉支架植入术治疗前循环颅内大血管及颈内动脉颅外段串联闭塞导致的急性缺血性卒中的有效性和安全性。方法选择2019年1-12月确诊的前循环颅内动脉闭塞合并同侧颈内动脉起始部重度狭窄或闭塞患者10例，采用球囊扩张颈内动脉起始部病变，通过导引导管后先行远端机械取栓再行颈动脉支架植入术。分别采用改良脑梗死溶栓血流分级（mTICI）、美国国立卫生研究院卒中量表（NIHSS）、改良Rankin量表（mRS）评价术后即刻闭塞血管再通情况、术后24 h神经功能缺损程度及术后90 d预后，记录术后症状性或非症状性颅内出血及手术并发症情况。结果 10例患者均顺利完成颅外血管支架植入术及远端支架取栓术，术后即刻mTICI 2b级5例、3级3例、2a级1例、0级1例，血管再通率8/10例；其中1例术后7 d颈内动脉颅外段再闭塞但临床症状无恶化。术后24 h症状明显改善6例，NIHSS评分均较基线下降≥ 4分。术后90 d mRS评分0分2例、1分1例、2分1例、3分4例、4分1例、6分1例（死亡），预后良好率4/10例。术后有4例发生非症状性颅内出血。结论远端机械取栓结合同期颈动脉支架植入术是一种治疗前循环颅内大血管及同侧颈内动脉颅外段串联闭塞致急性缺血性卒中的可行方法。

关键词: 卒中, 脑缺血, 动脉闭塞性疾病, 颈内动脉, 支架

Abstract:

Objective To investigate the availability and safety of distal mechanical embolization combined with simultaneous carotid stenting for acute ischemic stroke due to anterior circulation tandem occlusion of large intracranial vessels and carotid artery. Methods Ten patients with anterior circulation intracranial artery occlusion combined with severe stenosis or occlusion at the beginning of ipsilateral internal carotid artery were selected in Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University from January to December 2019. All patients were treated with balloon dilation for the lesion at the beginning of the artery. The distal end of the catheter was removed through the guide catheter, and then the carotid stent implantation was performed. Immediately after surgery, modified Thrombolytic in Cerebral Infarction (mTICI) was used to evaluate vascular recanalization. The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the degree of neurological deficit 24 h after surgery, and the modified Rankin Scale (mRS) was used to evaluate the prognosis of 90 d after surgery, and recorded symptomatic intracranial hemorrhage, non-symptomatic intracranial hemorrhage, and surgical complications. Results All patients completed the surgery. The immediate postoperative intracranial vessel mTICI was 2b grade in 5 cases, 3 grade in 3 cases, 2a grade in one case, and 0 grade in one case. The revascularization rate was 8/10. Of the 8 patients with successful revascularization, one patient (12.50%) occurred reocclusion the extracranial segment of the internal carotid artery at 7 d after surgery, but the clinical symptoms were not worsen. Six patients had a NIHSS score ≥ 4 points which were lower than baseline 24 h after surgery, and their symptoms improved significantly; 90 d postoperative mRS score was 0 in 2 cases, 1 in one case, 2 in one case, 3 in 4 cases, 4 in one case, and 6 in one case (died). The rate of good was 4/10. Four cases presented non-symptomatic intracranial hemorrhage. No symptomatic intracranial hemorrhage and other complications occurred. Conclusions Distal embolization combined with simultaneous carotid stenting is a feasible strategy for acute ischemic stroke due to anterior circulation tandem occlusion.

Key words: Stroke, Brain ischemia, Arterial occlusive diseases, Carotid artery, internal, Stents

凌冶平, 张广, 徐善才, 史怀璋. 前循环串联闭塞致急性缺血性卒中血管内治疗[J]. 中国现代神经疾病杂志, 2020, 20(11): 993-999.

LING Ye-ping, ZHANG Guang, XU Shan-cai, SHI Huai-zhang. Endovascular treatment for acute ischemic stroke due to the anterior circulation tandem occlusion[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(11): 993-999.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I11/993

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Endovascular treatment for acute ischemic stroke due to the anterior circulation tandem occlusion

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