症状性颅内大动脉亚急性及慢性闭塞血管内再通治疗的初步经验  

Endovascular recanalization of symptomatic subacute and chronic occlusion of large intracranial artery: Initial clinical experience and technical considerations

作　　者：马林[1] 方淳 封灏 徐霁充 严烁 韩洪杰[1] 谭华桥 Ma Lin;Fang Chun;Feng Hao;Xu Jichong;Yan Shuo;Han Hongjie;Tan Huaqiao(Department of Interventional Radiology,Shanghai Tongji Hospital,Tongji University School of Medicine, Shanghai 200065,China)

机构地区：[1]同济大学医学院上海市同济医院介入科,200065

出　　处：《中华神经外科杂志》2019年第2期166-171,共6页Chinese Journal of Neurosurgery

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

摘　　要：目的 评估颅内大动脉亚急性及慢性闭塞血管内再通治疗的可行性、安全性及有效性。 方法 连续回顾性分析2015年10月至2017年9月同济大学医学院上海市同济医院介入科采用血管内再通治疗的11例颅内大动脉亚急性及慢性闭塞患者的临床资料。评价血管内再通治疗的技术成功率、围手术期并发症及术后临床和血管造影的随访效果,采用改良Rankin量表评分(mRS)评估患者的预后。 结果 11例患者中,10例成功再通,1例不完全再通[脑梗死溶栓分级(TICI)2a级]。术中发生并发症8例:7例为末梢栓塞事件,其中症状性1例,无症状性6例,1例同时合并血管夹层;另1例为支架取栓相关的脑出血。术后除1例并发脑出血的患者失访之外,其他10例患者均获得3~12个月的血管造影和临床随访,结果显示不完全再通的1例患者术后3个月病变段血管再闭塞;9例成功再通的患者中,1例术后12个月发生支架内再狭窄并发短暂性脑缺血发作,其余8例血管造影随访均无血流动力学意义上的再狭窄,且无再发卒中及短暂性脑缺血发作。1例再闭塞的患者术后90 d 的mRS评分为4分,其余9例为0~1分。 结论 对于颅内大动脉亚急性及慢性闭塞的患者,在严格筛选病例的前提下,采取血管内再通技术安全可行,短期内能够改善患者的缺血症状,降低再发卒中率,但远期疗效尚需长期随访证实。Objective To investigate the feasibility, safety and efficacy of endovascular recanalization of symptomatic subacute and chronic occlusion of large intracranial artery. Methods During the period from October 2015 to September 2017, 11 patients with symptomatic subacute and chronic occlusion of large intracranial artery were treated with endovascular recanalization at Department of Interventional Radiology of Shanghai Tongji Hospital, Tongji University School of Medicine. We retrospectively analyzed the patients' clinical and imaging data to evaluate the rate of perioperative complications and follow-up results.Results Recanalization was successful in 10 of 11 patients and incomplete recanalization (2a based on Thrombolysis in Cerebral Infarction classification) was achieved in 1. Intraoperative complications occurred in 8 cases and included peripheral vascular embolism in 7 (1 symptomatic and 6 asymptomatic cases). One case was complicated with artery dissection and intracerebral hemorrhage associated with embolectomy occurred in another case. One patient was lost to follow-up and 10 patients received angiography and clinical follow-up for 3-12 months. The results of angiography follow-up showed that the stenosis artery segment of patient with incomplete recanalization was blocked again at 3 months. Of the 9 patients with complete recanalization, 1 patient developed in-stent restenosis at 12 months and suffered transient ischemic attack (TIA). The other 8 patients had no hemodynamic restenosis and no recurrence of TIA or stroke. The mRS (modified Rankin scale) score at 3-month follow-up was 0-1 in 9 patients and 4 in 1.Conclusions For patients with symptomatic subacute and chronic occlusion of large intracranial artery, on the premise of strict screening cases, mechanical recanalization is technically feasible and could improve the patient' symptoms in short term and reduce the recurrence rate of stroke. Its long-term effect, however, needs to be confirmed by longer follow-up.

关 键 词：动脉闭塞性疾病 脑血管造影术 脑血管重建术 手术中并发症 

分 类 号：R651.12[医药卫生—外科学]