导丝留置技术在急性脑动脉闭塞机械取栓中的应用  

The application of indwelling guide-wire technique in performing mechanical thrombectomy for acute cerebral artery occlusion

作　　者：许岗勤[1] 王子亮[1] 汪勇锋[1] 梁晓东[1] 李立[1] 李天晓[1] 

机构地区：[1]郑州大学人民医院(河南省人民医院)脑血管介入治疗中心,450003

出　　处：《介入放射学杂志》2017年第3期202-205,共4页Journal of Interventional Radiology

摘　　要：目的探讨导丝留置技术在急性脑动脉闭塞机械取栓术中的应用价值、安全性及可行性。方法回顾分析2015年10月至2016年2月采用机械取栓治疗的15例急性缺血性脑卒中患者临床资料,其中大脑中动脉闭塞6例,颈内动脉及大脑中动脉闭塞5例,椎基底动脉闭塞4例。采用导丝留置技术快速准确判断血管闭塞特征,进行血管内机械取栓术治疗。结果 15例患者经导丝留置技术均成功准确判断病变血管闭塞特征。13例(87%)闭塞血管即刻再通,其中10例脑梗死溶栓后血流分级(TICI)评分达3分,5例2b分;2例因血栓负荷量大、闭塞节段长,多次取栓效果不佳,血管再通失败。美国国立卫生研究院卒中量表(NIHSS)评分由术前19.2±7.0改善至术后1周6.3±3.6,差异有统计学意义(P<0.01)。术后3个月10例改良Rankin量表(m RS)评分≤2分。结论机械取栓治疗急性脑血管闭塞安全有效,导丝留置技术可安全、方便快捷、准确地判断出闭塞血管特征,减少手术操作,降低手术并发症,提高血管再通率。Objective To discuss the application value, safety and feasibility of indwelling guide- wire technique in performing mechanical thrombectomy for acute cerebral artery occlusion. Methods The clinical data of 15 patients with acute isehemie stroke, who were treated with mechanical thromnectomy at authors＇ hospital during the period from December 2015 to February 2016, were retrospectively analyzed. The diseases included middle cerebral artery occlusion （n=6）, internal carotid artery and middle cerebral artery occlusion （n=5） and vertebral basilar artery occlusion （u=4）. Indwelling guide-wire technique was adopted to quickly and accurately determine the vascular occlusion characteristics, then, endovascular mechanical thrombectomy was carried out. Results By using indwelling guide-wire technique, the occlusive features of the diseased arteries were successfully and precisely determined. Immediate recanalization of the occluded artery was obtained in 13 patients （87%）. The blood flow classification score after thrombolysis in cerebral infarction （TICI） reached 3 points in 10 patients and 2b points in 5 patients. In 2 patients, the vascular recanalization procedure failed because the thrombus load was large, the length of occluded segment was long, and the effect of mechanical thromnectomy was poor. According to American National Institutes of Health Stroke Scale （NIHSS）, the evaluation score was improved from preoperative （19.2±7.0） to postoperative （6.3±3.6）, the difference was statistically significant （P〈0.05）. Three months after the treatment, the score measured by modified Rankin scale（mRS） was ≤2 points in 10 patients. Conclusion Mechanical thrombectomy is safe and effective for the treatment of acute cerebral artery occlusion. The indwelling guide-wire techniquecan safely, conveniently, quickly and accurately determine the characteristics of the occluded blood vessels, which is very helpful in assisting surgical manipulation, reducing procedure- related complicat

关 键 词：急性缺血性脑卒中 机械取栓 导丝留置 SOLITAIRE AB支架 

分 类 号：R743.3[医药卫生—神经病学与精神病学]