Solitaire AB型支架取栓治疗急性大脑中动脉栓塞疗效分析  

Solitaire AB stent thrombectomy for the treatment of acute middle cerebral artery occlusion: analysis of curative effect

作　　者：王洪生[1] 刘圣[2] 赵林波[2] 周春高[2] 夏金国[2] 祖庆泉[2] 施海彬[2] 

机构地区：[1]南京医科大学附属南京明基医院老年科,210019 [2]南京医科大学第一附属医院介入放射科

出　　处：《介入放射学杂志》2015年第8期658-661,共4页Journal of Interventional Radiology

摘　　要：目的探讨Solitaire AB型支架取栓术治疗急性颅内血管栓塞的安全有效性及操作技术要点。方法 2011年12月至2014年3月南京医科大学第一附属医院采用Solitaire AB型支架取栓术治疗21例大脑中动脉(MCA)栓塞患者,其中单纯MCA栓塞14例,伴发颈内动脉颅内段闭塞7例;有房颤病史患者11例。分析即时取栓效果、术后出血情况,对比患者术前和术后美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(m RS)评分。结果 21例患者均顺利完成取栓手术,术中未出现死亡等严重并发症,术后即时脑梗死溶栓(TICI)血流分级为平均(2.6±0.5)级。术中留置支架10例,有房颤病史患者留置支架比例低于无房颤病史患者(P=0.02)。术前和术后1周患者平均NIHSS评分分别为18.4±6.0和6.7±9.7,差异有统计学意义(P<0.001)。术后2例患者因大面积脑梗死或梗死后出血死亡,其余患者症状均有不同程度改善,术后3个月m RS评分≤2分者17例。结论 Solitaire AB型支架取栓术治疗急性MCA血栓栓塞可获得较高的血管再通率,操作安全简便,临床预后较好。Objective To evaluate the safety and efficacy of Solitaire AB stent thrombectomy for acute middle cerebral artery （MCA） occlusion, and to discuss its technical points. Methods Between December 2011 and March 2014, a total of 21 patients with acute MCA occlusion underwent thrombectomy by using Solitaire AB stent at First Affiliated Hospital of Nanjing Medical University. Of the 21 patients, simple MCA occlusion was seen in 14, 7 of them was accompanied with ipsilateral distal internal carotid artery occlusion. Eleven patients had a history of atrial fibrillation. The instant thrombectomy effect, postoperative bleeding, the preoperative and postoperative National Institutes of Health Stroke Scale （NIHSS） scores, modified Rankin scale （mRS） scores were determined, and the results were analyzed. Results Technical success was achieved in all 21 patients, and no severe complications such as death occurred during the procedure. The average flow classification of postoperative immediate cerebral infarction （TICI） was grade of 2.6±0.5. The mean number of stents used in each patient was 10, and the number of stents used in patients with atrial fibrillation was less than that used in patients with no atrial fibrillation （P=0.02）. The mean NIHSS scores determined before and one week after the operation were 18.4±6.0 and 6.7±9.7 respectively, the difference was statistically significant （P〈0.001）. After the treatment, two patients died due to major ischemic stroke or post-infarction intracranial hemorrhage, and clinical symptoms were improved in different degrees in the remaining patients. Three months after the operation, the mRs scores was ≤2 in 17 patients. Conclusion For the treatment of acute middle cerebral artery occlusion, Solitaire AB stent thrombectomy can get higher vascular recanalization rate; this technique is technically simple and clinically safe with satisfactory clinical outcome.

关 键 词：脑梗死 大脑中动脉 血栓清除术 Solitaire支架 

分 类 号：R651.1[医药卫生—外科学]