颅内大血管闭塞致急性缺血性卒中多模式血管内治疗研究  

Multi-modal revascularization for acute ischemic stroke caused by intracranial vascular occlusion

作　　者：沈媛[1] 侍海存[1] 宋远营 潘平雷[1] SHEN Yuan;SHI Hai-cun;SONG Yuan-ying;PAN Ping-lei(Department of Neurology, Yancheng Third People＇s Hospital, Yancheng 224008, Jiangsu, Chin)

机构地区：[1]江苏省盐城市第三人民医院神经内科,224008

出　　处：《中国现代神经疾病杂志》2018年第5期355-359,共5页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的探讨颅内大血管闭塞致急性缺血性卒中多模式血管内治疗的有效性和安全性。方法共16例颅内大血管闭塞致急性缺血性卒中患者分别为左侧和右侧颈内动脉眼动脉段栓塞各2例(4/16)、左侧大脑中动脉M1段栓塞4例(4/16)、左侧大脑中动脉M2段栓塞1例(1/16)、右侧大脑中动脉M1段栓塞3例(3/16)、左侧大脑前动脉与大脑中动脉分叉部栓塞3例(3/16)、基底动脉中下部动脉粥样硬化血栓形成1例(1/16),采用多模式血管内治疗(包括导管抽吸、机械取栓、动脉溶栓、球囊扩张术和支架植入术),术后即刻采用脑梗死溶栓血流分级(TICI)评价血管再通、入院时和术后21 d美国国立卫生研究院卒中量表(NIHSS)评价神经功能、术后3个月改良Rankin量表(m RS)评价预后,并记录术后并发症发生情况。结果 16例患者中6例(6/16)实现完全血管再通(TICI分级3级),8例(8/16)实现部分血管再通(TICI分级2级),包括TICI分级2a级1例(1/16)、TICI分级2b级7例(7/16),2例(2/16)未实现血管再通(TICI分级0~1级)。术后21 d NIHSS评分低于入院时[12.50(6.75,19.25)分对18.00(13.25,21.50)分;Z=-2.287,P=0.022]。术后3个月m RS评分1分者2例(2/16),2分4例(4/16),3分5例(5/16),4分2例(2/16),5分2例(2/16),6分1例(1/16)。术后并发肺部感染2例(2/16),牙龈出血1例(1/16),原发梗死灶发生缺血性卒中出血性转化3例(3/16),包括HI2型2例(2/16)、PH1型1例(1/16)。结论多模式血管内治疗方法如导管抽吸、机械取栓、动脉溶栓、球囊扩张术和支架植入术治疗颅内大血管闭塞致急性缺血性卒中安全、有效,可以明显改善患者生活质量。Objective To investigate the effectiveness and safety of multi-modal endovasculartreatment on acute ischemic stroke caused by intracranial vascular occlusion. Methods Sixteen caseswith acute ischemic stroke were studied, within which 4 cases were found respectively with left and rightinternal carotid artery（ICA） ophthalmic artery（OA） segment embolism（4/16）, 4 cases were found occlusionat left M1 segment of middle cerebral artery（MCA, 4/16）, one case was found occlusion at left M2 segmentof MCA（1/16）, 3 cases were found occlusion at right M1 segment of MCA（3/16）, 3 cases were foundocclusion at bifurcation of left anterior cerebral artery（ACA） and MCA（3/16）, and one case was foundatherosclerotic stenosis with thrombosis at middle and lower segment of basal artery（BA, 1/16）. Theyunderwent multi-modal endovascular treatment, including thrombus aspiration, mechanical thrombectomy,intra-arterial thrombolysis, balloon dilatation and stent implantation. The Thrombolysis in CerebralInfarction（TICI） was used to evaluate the recanalization immediately after operation. National Institutes ofHealth Stroke Scale（NIHSS） was used to evaluate neurological function on admission and 21 d afteroperation, and modified Rankin Score（m RS） was used to evaluate the prognosis 3 months after treatment.Postoperative complications were recorded. Results Complete recanalization was found in 6 cases（6/16,TICI 3）, 8 cases were found partial recanalization（TICI 2, 8/16）, including TICI 2 a in one case（1/16） and TICI 2 b in 7 cases（7/16）, and no recanalization was found in other 2 cases（TICI 0-1, 2/16）. NIHSS score21 d after operation was significantly lower than that on admission [12.50（6.75, 19.25） score vs. 18.00（13.25, 21.50） score; Z =-2.287, P = 0.022]. Followed-up for 3 months, m RS score was 1 in 2 cases（2/16）,2 in 4 cases（4/16）, 3 in 5 cases（5/16）, 4 in 2 cases（2/16）, 5 in 2 cases（2/16） and 6 in one case（1/16）.Postoperative complications i

关 键 词：卒中 脑缺血 动脉闭塞性疾病 脑动脉 血栓切除术 支架 血栓溶解疗法 

分 类 号：R743.3[医药卫生—神经病学与精神病学]