急性颈内动脉末端闭塞双支架取栓技术治疗的应用体会  

Experience in treatment of acute internal carotid artery end occlusion with double stent thrombectomy technique

作　　者：丁桂兵[1] 吴岩峰[1] 陈亮[1] 吴晋[1] DING Guibing;WU Yanfeng;CHEN Liang;WU Jin(Department of Neurology,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210002,China)

机构地区：[1]南京医科大学第二附属医院神经内科,江苏南京210003

出　　处：《中国医药科学》2018年第23期249-253,共5页China Medicine And Pharmacy

摘　　要：目的急性颈内动脉颈内动脉末端闭塞预后差,本研究旨在观察双支架取栓技术在急性颈内动脉末端闭塞中应用的有效性与安全性。方法 2016年9月～2018年2月南京医科大学第二附属医院神经内科采用双支架取栓技术治疗的6例心源性栓塞导致的急性颈内动脉末端闭塞患者。所有患者大脑中动脉闭塞使用Solitaire AB(6×30mm)支架,大脑前动脉闭塞使用Solitaire AB(4×20mm)支架。结果 5例(5/6)例取栓后再通成功,mTICI达到3级;1例血栓负荷太大向远端前移未成功,mTICI 1级。穿刺到再通时间为58～126min,中位时间90min;术中新发远端栓塞1例,大面积脑梗死脑疝形成死亡2例,其中1例行去骨瓣减压术。随访3个月期间无新发脑卒中、短暂性脑血缺血发作及死亡等事件,无再次闭塞发生。结论使用双支架取栓技术治疗急性颈内动脉末端闭塞安全可行,能够取得较高的开通率。Objective To observe the safety and effectiveness and safety of double stent thrombectomy technique in acute internal carotid artery end occlusion as the prognosis of acute internal carotid artery end occlusion is poor.Methods Six patients with acute internal carotid artery end occlusion caused by cardioembolism who were treated in department of Neurology of The Second Affiliated Hospital of Nanjing Medical University from September 2016 to February 2018 were selected.Solitaire AB(6×30mm)stent was used for middle cerebral artery occlusion in all patients,and Solitaire AB(4×20mm)stent was used for anterior cerebral artery occlusion.Results After thrombectomy,5 cases were successfully with recanalization and the mTICI reached level 3.In one case,the thrombus load was so large that the distal anterior shift was unsuccessful,and the mTICI1 reached level 1.The time from puncture to recanalization was 58-126min,and the median time was 90 mins.New distal embolization occurred in 1 patient and large area cerebral infarction in 2 patients died of hernia formation,among which 1 patient underwent decompressive craniectomy.No new stroke,transient ischemic attack,death event and re-occlusion occurred during the 3-month follow-up period.Conclusion Double stent thrombectomy technique in acute internal carotid artery end occlusion is safe and feasible and it can achieve a higher recanalization rate.

关 键 词：急性颈内动脉颈内动脉末端闭塞 双支架取栓技术 有效性 安全性 

分 类 号：R743.3[医药卫生—神经病学与精神病学]