Solitaire AB在前循环远端动脉急性闭塞取栓治疗中的初步应用  

Preliminary application of Solitaire AB in the thrombectomy of acute arterial occlusion of distal anterior circulation

作　　者：方亦斌[1] 文婉玲 张永巍[1] 黄清海[1] 刘建民[1] 

机构地区：[1]第二军医大学长海医院脑血管病中心,上海200433

出　　处：《中国脑血管病杂志》2015年第8期430-434,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：上海市科委产学研项目(13441901102);长海医院1255课题(CH125550400)

摘　　要：目的探讨应用机械取栓装置SolitaireAB治疗颅内动脉远端闭塞所致前循环急性缺血性卒中的效果。方法回顾性分析采用SolitaireAB取栓装置治疗的9例前循环远端动脉闭塞患者的资料，其中大脑中动脉M2段闭塞7例，大脑前动脉A3段闭塞2例。分析9例患者的临床特征、影像学资料、治疗及术后3个月临床随访结果。以支架取栓后再通率、治疗前后美国国立卫生研究院卒中量表（NIHSS）评分及术后3个月随访时改良Rankin量表（mRS）评分评估治疗的有效性，以手术相关并发症、病死率评估治疗的安全性。结果（1）9例患者中，8例成功再通，改良脑梗死溶栓试验（mTICI）分级2b或3级。（2）出院时NIHSS评分中位数9．5（3．0，15．5）分，较术前19．0（16．0，22．0）分明显下降（Z=2．703，P=0．007），未发生操作相关永久性并发症。再通的8例患者中，4例预后良好（mRS评分为0—1分），4例残疾（mRS评分为3～4分）；未再通的1例患者术后3个月随访时mRS评分为4分。结论颅内动脉M2段或A3段急性闭塞时，使用SolitaireAB取栓效果较好，其有效性、安全性及适应证尚需更大样本的对照研究进一步探索。Objective To investigate the effect of mechanical thrombectomy device Solitaire AB for the treatment of distal occlusion of the intraeranial artery caused acute anterior circulation ischemic stroke. Methods The clinical data of 9 patients with arterial occlusion of distal anterior circulation treated by using the Solitaire AB thrombectomy device were analyzed retrospectively. Seven of them had M2 middle cerebral artery occlusion and 2 had A3 occlusion. Their clinical features, imaging data, treatment, and the results of 3-month clinical follow-up were analyzed. The effectiveness of treatment was evaluated through the recanalization rate after stent thrombectomy,the National Institutes of Health Stroke Scale （NIHSS） scores before and after treatment, the modified Rankin scale （ mRS ） scores, and the 3-month clinical follow-up results. The surgery-related complications and mortality of patients were used to evaluate the safety of the treatment. Results （ 1 ） Of the 9 intraeranial arterial occlusions, 8 were recanalized successfully. The modified thrombolysis in cerebral infarction （mTICI） was 2b or grade 3. （2） The NIHSS score median 9.5 （3.0,15.5） at discharge dropped significantly compared with 19.0 （16.0,22.0） before procedure. （ Z = 2. 703, P = 0. 007 ）. No permanent complications related to operation occurred. Four of the recanalized patients had good prognosis （ mRS 0 -1 ） and 4 had disability （ mRS 3 -4 ）. The mRS score of one non-recanalized patient was 4 at the 3 months follow-up. Conclusion The embolectomy effect is good whom using Solitaire AB device for acute occlusion occurred in the intracranial artery M2 or A3 segment. Its efficacy, safety, and indications still need to be further explored in a larger sample controlled trial.

关 键 词：脑梗死 急性 血管内治疗 取栓装置 

分 类 号：R743.3[医药卫生—神经病学与精神病学]