SolitaireAB型支架机械取栓治疗急性缺血性卒中  

Solitaire AB stent thrombectomy for the treatment of acute ischemic stroke

作　　者：孙丰兵 李轶[2] 荆朝晖[2] 杨晓笙[2] 华续明[2] 万亮[2] 

机构地区：[1]上海交通大学医学院附属新华医院崇明分院神经外科,上海202150 [2]上海交通大学医学院附属新华医院神经外科,上海200092

出　　处：《中国急救医学》2016年第12期1069-1073,I0013,共6页Chinese Journal of Critical Care Medicine

基　　金：国家自然科学基金（81300994）

摘　　要：目的探讨SolitaireAB型支架取栓术治疗急性颅内血管栓塞的有效性、安全性及技术要点。方法2015—01～2016—01上海交通大学医学院附属新华医院神经外科应用SolitaireAB型支架取栓治疗42例颅内大血管急性栓塞患者，其中大脑中动脉（MCA）栓塞28例；颈内动脉颅内段（ICA）闭塞7例；伴有大脑前、中动脉栓塞2例；基底动脉（BA）栓塞5例，分析开通的耗时、效果及术后情况。对比分析患者术前、出院时美国国立卫生研究院卒中量表（the National Institutes of Health Stroke Scale，NIHSS）评分及随访90d时改良Rankin量表（modified Rankin Scale，mRS）。结果所有患者均在入院后30min～2h进行穿刺，平均（59．31±33．58）min。仅3例（7．14％）未开通。从发病到开通的时间为3．5—7．0h（超过6h4例），平均（5．289±0．932）h。死亡7例，来院时NIHSS评分18～30分。90dmRS〉2有18例（42．85％），来院时NIHSS评分13～28分，15分以下2例。90dmRS≤2有24例（57．15％），来院时NIHSS评分10—18分，其中15分以上3例。大部分栓子病理检查为血栓。术后CT及MRI检查发现，出现大面积脑梗死及严重的梗死性出血共10例，基底节区梗死5例，小片状梗死3例，少量梗死性出血5例，散在多发小梗死8例。出院时NIHSS评分0～18分，平均（6．58±5．72）分。结论运用SolitaireAB型支架进行动脉取栓能获得较好的再通率，且安全有效。每个患者的有效取栓时间窗不完全一致，有效时间窗内开通将进一步提高患者的预后。Objective To explore the technical note and to evaluate the safety and efficacy of Solitaire AB stent thrombectomy for acute intracranial vascular embolization. Methods From January 2015 to January 2016, Solitaire AB stent thrombectomy for treatment of acute ischemic stroke was ap- plied in 42 patients in our department, including 28 cases in middle cerebral artery （MCA）, 7 cases in internal carotid artery （ICA）, 2 cases in ICA combined with anterior cerebral artery （ACA） and MCA, 5 cases in basilar artery （BA）. Time-consuming of operation, result and outeoming were analyzed before surgery and at discharge. The patients were evaluated by the National Institutes of Health Stroke Scale （NIHSS） score. The patients were followed up for 90 days and evaluated by NIHSS and modified Ranki Scale （mRS）. All data were compared retrospectively. Results Femoral artery puncture was performed 30 minutes to 2 hours after adimission, an average （59.31 ±33.58）minutes. Non-recanalization was found in 3 cases （7.14%）. Time-consuming from onset to recanalization was （5.289±0.932） hours averagely （3.5-7 hours）, 4 cases were found more than 6 hours. Seven patients died, whose NIHSS score was from 18 to 30 preoperative. Followed-up of 90 days, modified Rankin Scale （mRS） was more than 2 in 18 cases （42.85%）, whose NIHSS scale was from 13 to 28, of which NIHSS score was less than 15 in 2 cases. Followed-up of 90 days, modified Rankin Scale （mRS） was less than 2 in 24 cases （57.15%）, whose NI- HSS score was from 10 to 18 preoperative, which score was more than 15 in 3 cases. The emboli was diagnosed of thrombosis by pathological examination. Postoperative, the severe cerebral infarction and infarction hemorrhages was found in 10 cases by CT and MRI scan, Basal ganglia infarction in 5 cases, slight infarction hemorrhages in 5 cases, platelet infarction in 3 cases, multiple small infarction in 8 cases. At discharge, NHISS score was from 0 to 18, （6.58±5.72）averagely. Conclusion

关 键 词：SOLITAIRE AB型支架 急性卒中 取栓 有效时间窗 NIHSS评分 

分 类 号：R783.1[医药卫生—口腔医学]