摘要：

目的 探讨Solitaire 支架血管内机械取栓治疗急性大脑中动脉闭塞致缺血性卒中的有效性和安全性，并筛查影响预后的相关因素。方法 共25 例急性大脑中动脉M1 段闭塞致缺血性卒中患者均采用Solitaire支架血管内机械取栓，记录发病至股动脉穿刺时间、股动脉穿刺至血管再通时间、血管内机械取栓次数、取栓前是否静脉溶栓、是否行球囊扩张术和（或）支架植入术、取栓后是否动脉溶栓、术后是否应用替罗非班；术后即刻采用脑梗死溶栓血流分级（TICI）评价血管再通情况，术后24 h 采用美国国立卫生研究院卒中量表（NIHSS）评价神经功能，术后90 d 采用改良Rankin 量表（mRS）评价临床预后；记录术后24 h 症状性颅内出血发生率和术后90 d 内病死率。结果 25 例患者发病至股动脉穿刺中位时间5.00（4.00，6.30）h，股动脉穿刺至血管再通中位时间2.00（2.00，2.50）h，血管内机械取栓次数2（2，2）次，7 例（28%）先行静脉溶栓再桥接血管内机械取栓，6 例（24%）行单纯球囊扩张术，3 例（12%）行单纯支架植入术，4 例（16%）行球囊扩张术和支架植入术，4 例（16%）取栓后行动脉溶栓，11 例（44%）术后应用替罗非班；20 例（80%）血管再通（TICI 分级2b ~ 3 级）；术后24 h NIHSS 评分低于入院时［8（4，12）分对14（11，17）分；Z = -3.532，P = 0.000］，3 例（12%）发生症状性颅内出血；术后90 d 15 例（60%）预后良好（mRS 评分≤ 2 分），2 例（8%）死亡。单因素和多因素前进法Logistic 回归分析显示，TICI分级2b ~ 3 级是血管内机械取栓预后良好的独立因素（OR = 0.316，95%CI：0.102 ~ 0.982；P = 0.046）。结论 Solitaire 支架血管内机械取栓治疗急性大脑中动脉闭塞致缺血性卒中安全、有效，且大脑中动脉再通级别越高、预后越佳。

关键词: 卒中, 脑缺血, 大脑中动脉, 血栓切除术, 支架, 血管造影术, 数字减影

Abstract:

Objective  To assess the efficacy and safety of thrombectomy with Solitaire stent for treatment of acute middle cerebral artery occlusion (MCAO), and to identify the predictive factors for clinical outcome.  Methods  A total of 25 patients with acute middle cerebral artery (MCA)-M1 segment occlusion were treated by thrombectomy with Solitaire stent. Time from onset to femoral artery puncture, time from femoral artery puncture to recanalization, times of thrombectomy, thrombolytic therapy or not, balloon dilatation and/or stent implantation, intraarterial thrombolysis or not, tirofiban treatment after therapy or not were recorded. Vascular recanalization immediately after procedure was evaluated by Thrombolysis in Cerebral Infarction (TICI). National Institutes of Health Stroke Scale (NIHSS) was used to evaluate neurological function of patients 24 h after operation, and the clinical outcomes were assessed by modified Rankin Scale (mRS) at 90 d after treatment. The occurrence rate of symptomatic intracranial hemorrhage within 24 h after operation and mortality within 90 d after treatment were recorded.  Results  Median time from onset to femoral artery puncture was 5.00 (4.00, 6.30) h; median time from femoral artery puncture to recanalization was 2.00 (2.00, 2.50) h; times of thrombectomy was 2 (2, 2); 7 patients (28%) received intravenous thrombolysis before thrombectomy; 6 patients (24%) underwent balloon dilatation only; 3 patients (12%) underwent stent implantation only; 4 patients (16%) underwent balloon dilatation and stent implantation; 4 patients (16%) received intraarterial thrombolysis after thrombectomy; 11 (44%) received tirofiban therapy after operation. There were 20 patients (80% ) of recanalization with TICI 2b-3 grade. The NIHSS score at 24 h after operation was significantly decreased than before procedure [8 (4, 12) score vs. 14 (11, 17) score; Z = -3.532, P = 0.000]. Symptomatic intracranial hemorrhage occurred in 3 patients (12%). At 90 d after treatment, 15 patients (60%) had favorable prognosis (mRS ≤ 2 score). Two patients (8%) died. Univariate and multivariate forward Logistic regression analysis showed the TICI 2b-3 grade was independent factor for favorable prognosis (OR = 0.316, 95% CI: 0.102-0.982; P = 0.046).  Conclusions  Thrombectomy with Solitaire stent is safe and effective for treating acute MCAO. With the increase of TICI grade, the prognosis is better.

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