前循环症状性颅内大动脉非急性期闭塞血管内再通治疗的初步研究  

Endovascular recanalization of the symptomatic non-acute occlusion of large intracranial artery of circulation: preliminary study

作　　者：谭华桥[1] 王永亮[2] 马林 封灏[1] 刘渊华[3] 方淳 徐霁充[1] 严烁[1] 韩洪杰[1] Tan Huaqiao;Wang Yongliang;Ma Lin;Feng Hao;Liu Yuanhua;Fang Chun;Xu Jichong;Yan Shuo;Han Hongjie(Department of Interventional Radiology,Tongji Hospital Affiliated of Tongji University,Shanghai 200065, China;Department of lnterventional Radiology,the Fourth Division Hospital of Xinjiang Production and Construction Corps,Yining 835000,China;Department of Neurology,Tongji Hospital Affiliated of Tongfi University,Shanghai 200065,China)

机构地区：[1]同济大学附属同济医院介入科,上海200065 [2]新疆生产建设兵团第四师医院介入科,伊宁835000 [3]同济大学附属同济医院神经内科,上海200065

出　　处：《中华放射学杂志》2019年第1期50-56,共7页Chinese Journal of Radiology

基　　金：上海市科学计划委员会科研计划(14DZ1941205);上海市卫生和计划生育委员会科研课题(20174Y0095).

摘　　要：目的探讨前循环症状性颅内大动脉非急性期闭塞,血管内再通治疗的可行性、安全性及疗效。方法本研究为前瞻性,2015年10月至2017年12月对符合入选和排除标准的13例前循环症状性颅内大动脉非急性期闭塞患者行血管内再通治疗。术后记录最初的手术结果(包括血管内再通情况、围手术期并发症)以及血管造影和临床随访结果,评估出院时和术后90d神经功能改善情况。结果13例患者中,11例血管内再通。8例患者发生围手术期并发症,7例为末梢栓塞,其中症状性3例、无症状性4例,1例症状性末梢栓塞患者同时合并术中血管夹层;1例为支架取栓相关的脑出血。术后患者均未发生高灌注综合征。出院时,11例血管再通患者,10例症状好转、1例症状无明显改善;2例再通失败的患者,1例症状恶化、1例症状无明显变化。11例再通的患者,1例支架取栓后脑出血的失访;10例获得影像随访,1例术后12个月随访支架内80%狭窄、9例无血流动力学意义上的狭窄或闭塞。12例患者获得临床随访,1例再通患者支架内80%狭窄并再发TIA,9例无再发卒中或TIA发作,90d的改良Rankin量表(mRS)评分功能良好,中位mRS评分明显下降[术后1(0~2)分、术前2(1~4)分];2例再通失败的患者,90d的mRS评分功能恶化。结论对于前循环颅内大动脉非急性期闭塞患者,在严格筛选适应证的前提下,采取血管内再通治疗是可行、安全的,短期内可改善患者缺血症状,降低再发卒中率,但长期确切疗效还有待大样本长期随访研究证实。Objective To investigate the feasibility,safety and efficacy of endovascular recanalization of the symptomatic occlusion of large intracranial artery in anterior circulation.Methods From October 2015 to December 2017,13 patients with symptomatic non-acute occlusion of large intracranial artery in anterior circulation were enrolled into this study and underwent endovascular recanalization.The initial procedural results,including the rate of successful recanalization and perioprocedural complications,and angiographic and clinical follow-up results were collected.The functional outcome was evaluated at discharge and 90 days.Results Recanalization was successful in 11 out of 13 patients.Perioperative complications occurred in 8 cases,including distal embolization in 7 cases(3 with symptom and 4 without),in which intracerebral hemorrhage associated with embolectomy was found in 1 case;and distal embolization concomitant with artery dissection in 1 case.At discharge,the symptoms of 10 out of 11 patients with successful recanalization were improved and 1 was unchanged;one of 2 patients with recanalization failure was aggravated and 1 was unchanged.After the procedure,1 patient with successful recanalization,but complicated with intracerebral hemorrhage associated with embolectomy was lost at follow-up,thus angiographic follow-up was available in the remaining 10 patients.Of the 10 patients,1 patient developed in-stent restenosis at 12 months and 9 patients had no hemodynamic stenosis/reocclusion.The clinical follow-up was available in 12 patients.No recurrence of TIA or stroke was found in 9 cases with successful recanalization except for 1 case who developed in-stent stenosis and suffered from TIA.At the follow-up of 90 days,10 patients with successful recanalization showed good function(mRS: 0-2),2 patients with recanalization failure were deteriorated.Conclusions In strictly selected patients with symptomatic non-acute occlusion of large intracranial artery in anterior circulation,endovascular recanalization was feas

关 键 词：颅内动脉疾病 动脉闭塞性疾病 放射学 介入性 血管内再通 非急性期 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]