Solitaire AB支架取栓术治疗急性大脑中动脉闭塞八例  

Thrombectomy with Solitaire AB stent in the treatment of acute middle cerebral artery occlusion:eight cases report

作　　者：彭亚[1] 宣井岗[1] 陈荣华[1] 朱旭成[1] 杨伊林[1] 

机构地区：[1]苏州大学附属常州市第一人民医院神经外科,213003

出　　处：《中国脑血管病杂志》2011年第7期373-377,共5页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨采用SolitaireAB支架机械中取栓术治疗急性大脑中动脉(MCA)闭塞的疗效。方法回顾性分析2010年11月—2011年4月苏州大学附属常州市第一人民医院神经外科采用Solitaire AB支架,机械取栓术治疗的发病时间为4～7 h的急性MCA闭塞8例患者的临床资料。其中2例因术中造影显示M2段中的一分支动脉显影不佳,使用尿激酶20万U。结果①8例均获取栓成功,造影显示MCA再通;从微导管进入导引导管到血管重新开通时间为(25±5)min。其中使用尿激酶的1例患者术后有左侧颞、顶叶梗死,其余7例术后MRI或CT灌注虽显示病侧有小梗死灶,但患者功能恢复良好,无手术相关并发症和脑出血。术后1周,美国吲立卫生研究院卒中量表评分为4.7±1.2,与术前的14.9±0.9比较,差异有统计学意义(t=29.83,P<0.01)。②5例患者出院后1个月采用CT 血管成像(CTA)和 CT灌注随访,CTA显示取栓侧MCA均通畅,CT灌注显示2例的取栓侧血流量仍较正常侧差,3例的取栓侧血流量和正常侧相比,基本恢复正常。③出院后1～3个月随访改良Rankin评分,其中0分为4例,1分为2例,2分为2例。结论 Solitaire AB支架取栓技术缩短了闭塞血管的升通时间,提高了开通率,减少甚至不用溶栓药物;而且治疗急性MCA闭塞是安全、有效的。Objective To investigate the effect of mechanical thrombeetomy with a Solitaire AB stent in the treatment of acute middle cerebral artery （MCA） occlusion. Methods The clinical data of 8 patients with acute MCA occlusion （onset time 〈 4 -7 hours） treated by mechanical thrombectomy with a Solitaire AB stent in the Department of Neurosurgery, Changzhou NO. 1 People＇s Hospital Affiliated to Soochow University from November 2010 to April 2011 were analyzed retrospectively. Two of them were treated with 200 000 U of urokinase because the intraoperative angiography showed that an M2 segment developed poorly. Results ①Thrombeetomy was successful in 8 patients and angiography showed that MCA recanalization was achieved. The time from the microcatheter into the guiding catheter to the vascular recanalization was 25±5 minutes. One of the patients who used urokinase had left temporal lobe infarction after procedure. The other 7 showed small infarcts on MRI or CT perfusion imaging after procedure, however, the functional recovery of the patients was good. No procedure-related complications or intracranial hemorrhages were noted. The National Institutes of Health Stroke Scale （NIHSS） score was 4.7 ±1.2 one week after procedure compared to 14.9 ± 0.9 before procedure. There was significant difference （ t = 29.83, P 〈0.01 ）. ②5 patients were followed up with CTA and CT perfusion imaging 1 month after discharge. CTA showed that all MCAs were patent on the side of thrombectomy. CT perfusion imaging showed that the blood flow volume on the side of thrombectomy in 2 cases was worse than that on the normal side. Compared to the blood flow volume on the normal side, the side of thrombectomy in 3 patients almost returned to normal. ③1-3 months after discharge, the follow-up modified Rankin Scale （mRS） showed 0 in 4 cases,1 in 2 cases, and 2 in 2 cases. Conclusion The thrombectomy techniques of Solitaire stent may shorter the time of recanalization of vascular occlusion, improve the recanalization rate

关 键 词：颅内血栓形成 大脑中动脉 血栓切除术 SOLITAIRE AB支架 

分 类 号：R743.3[医药卫生—神经病学与精神病学]