摘要：

目的 探讨合并颅内外动脉狭窄的急性缺血性卒中患者血管内治疗过程中狭窄病变的处理策略。方法 共36 例合并颅内外动脉狭窄的急性缺血性卒中患者行单纯血管内治疗或桥接治疗，记录入院或住院期间病情突然加重至股动脉穿刺时间、股动脉穿刺至血管再通时间，术后即刻采用改良脑梗死溶栓血流分级（mTICI）评价血管再通情况，术后90 d采用改良Rankin量表（mRS）评价临床预后并记录症状性颅内出血发生率和病死率。结果 36 例患者中13 例（36.11%）行静脉溶栓桥接血管内机械取栓。颅内动脉狭窄21 例（58.33%）、颅外动脉狭窄15 例（41.67%），前循环狭窄16 例（44.44%）、后循环狭窄20 例（55.56%）。25 例（69.44%）采用支架取栓装置，11 例（30.56%）行球囊扩张术和（或）支架植入术。21 例颅内动脉狭窄患者中4 例单纯行球囊扩张，9 例植入Wingspan 自膨式支架，8 例植入Apollo 球囊扩张式支架；15例颅外动脉狭窄患者均行球囊扩张术和支架植入术。36例患者中33例（91.67%）血管再通（mTICI 分级2b ~ 3 级），21 例（58.33%）预后良好（mRS 评分≤ 2 分），2 例（5.56%）发生症状性颅内出血，5 例（13.89%）死亡，其中颅内动脉狭窄组与颅外动脉狭窄组、前循环狭窄组与后循环狭窄组预后良好率、症状性颅内出血发生率和病死率差异均无统计学意义（Fisher确切概率法：均P > 0.05）。结论 对于合并颅内外动脉狭窄的急性缺血性卒中患者血管内治疗安全、有效。

关键词: 卒中, 脑缺血, 血栓切除术, 支架, 血管成形术, 血管造影术, 数字减影

Abstract:

Objective  To investigate the management of stenosis lesions during endovascular treatment for acute ischemic stroke.  Methods  A total of 36 acute ischemic stroke patients combined with intracranial/extracranial arterial stenosis were treated with endovascular treatment or bridging treatment. Time from aggravation on admission or in hospital stay to femoral artery puncture, from femoral arterypuncture to recanalization were recorded. Modified Thrombolysis in Cerebral Infarction (mTICI) was usedto assess the recanalization immediately after operation. Modified Rankin Scale (mRS) was used to evaluate prognosis at 90 d after operation. Occurrence rate of symptomatic intracranial hemorrhage and mortality were recorded.  Results  Among 36 patients, 13 patients (36.11%) underwent intravenous thrombolysis and then endovascular thrombectomy. In all patients, there were 21 (58.33%) with intracranial stenosis and 15 (41.67%) with extracranial stenosis, 16 (44.44%) with anterior circulation stenosis and 20 (55.56%) with posterior circulation stenosis. Stent thrombectomy was used in 25 patients (69.44% ), while balloon dilatation and/or stent implantation was used in 11 patients (30.56% ). For 21 patients with intracranial arterial stenosis, 4 were treated with balloon dilatation only, 9 with Wingspan self-expandable stents and 8 with Apollo balloon-expandable stents. Fifteen patients with extracranial arterial stenosis were treated with balloon dilatation and stent implantation. A total of 33 patients (91.67%) achieved recanalization (mTICI 2b-3 grade), 21 patients (58.33% ) had good outcomes (mRS ≤ 2 score), while symptomatic intracranial hemorrhage occurred in 2 patients (5.56%) and 5 (13.89%) died. There were no statistically significant differences in the rate of good prognosis, symptomatic intracranial hemorrhage and mortality between intracranial and extracranial arterial stenosis, anterior and posterior circulation stenosis (Fisher exact probability: P > 0.05, for all). Conclusions  For acute ischemic stroke patients combined with intracranial/extracranial arterial stenosis, endovascular treatment is safe and effective.

Key words: Stroke, Brain ischemia, Thrombectomy, Stents, Angioplasty, Angiography, digital subtraction