抽吸取栓联合球囊扩张和(或)支架置入治疗急性颅内动脉粥样硬化性闭塞效果的初步分析  

Preliminary efficacy analysis of aspiration combined with balloon angioplasty and(or)stenting in patients with acute intracranial atherosclerosis-related occlusion

作　　者：王东 崔健[2] 姜海洋 邓剑平 赵振伟 陈虎 Wang Dong;Cui Jian;Jiang Haiyang;Deng Jianping;Zhao Zhenwei;Chen Hu(Department of Neurology,the Second Affiliated Hospital of Xi′an Medical College,Xi′an 710038,China)

机构地区：[1]西安医学院第二附属医院神经内科,710038 [2]西安市第一医院神经外科 [3]空军军医大学唐都医院神经外科

出　　处：《中国脑血管病杂志》2021年第12期843-850,859,共9页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨抽吸取栓联合球囊扩张和(或)支架置入治疗急性颅内动脉粥样硬化性闭塞(ICAS-O)的安全性及有效性。方法回顾性连续纳入2019年1月至2020年12月空军军医大学唐都医院神经外科(10例)、西安医学院第二附属医院神经内科(5例)及西安市第一医院神经外科(10例)采用抽吸取栓联合球囊扩张和(或)支架置入治疗急性ICAS-O患者25例,记录治疗前和治疗后1周美国国立卫生研究院卒中量表(NIHSS)评分、抽吸取栓后血管再通比例、血管成形方式、血管成功再通率、围手术期并发症、术后恢复情况等。采用症状性颅内动脉疾病华法林-阿司匹林研究(WASID)方法评价闭塞血管再通后残余狭窄率,狭窄率>70%为重度狭窄。根据改良脑梗死溶栓(mTICI)分级评估血管开通程度,mTICI分级2b~3级为成功再通。术后3个月对患者进行临床随访,改良Rankin量表(mRS)评分0~2分为预后良好,3~5分为预后不良,6分为死亡。手术相关并发症包括导丝导管穿出血管、球囊扩张致血管破裂、术中血栓形成、术中血管夹层及症状性颅内出血。根据海德堡出血分级,症状性颅内出血定义为术后48 h内NIHSS评分增加4分以上。结果25例患者均行抽吸取栓,其中14例(56.0%)抽吸取栓后正向血流恢复,提示重度狭窄;行单纯球囊扩张6例,行球囊扩张+支架置入8例;11例(44.0%)抽吸取栓后正向血流未恢复,中间导管无法通过闭塞处,行单纯球囊扩张5例,行球囊扩张+支架置入6例。术后即刻血管成功再通24例(96.0%),血流均达mTICI分级3级;血管未通1例(4.0%),mTICI分级2a级。发病至股动脉穿刺时间80~1440 min,中位穿刺时间为420(300,660)min。手术时间45~150 min,中位时间60(30,60)min。术后1周平均NIHSS评分低于术前,治疗前后的差异有统计学意义[(5.2±1.4)分比(16.4±2.1)分,t=5.2,P<0.01]。25例患者未发生手术相关并发症。术后3个月随访,预后良好者18例,占72.0%;�Objective To explore the efficacy and safety of aspiration combined with balloon angioplasty and(or)stenting in patients with acute intracranial atherosclerosis-related occlusion(ICAS-O).Methods All 25 patients with acute ICAS-O treated by aspiration combined with balloon angioplasty and stenting in the Neurosurgery Department of Tangdu Hospital,Air Force Medical University(10 cases),the Neurology Department of the Second Affiliated Hospital of Xi′an Medical College(5 cases)and the Neurosurgery Department of the First Hospital of Xi′an City(10 cases)from January 2019 to December 2020 were retrospectively analyzed.The National Institute of Health Stroke Scale(NIHSS)scores before treatment and 1 week after treatment,recanalization rate after aspiration,the mode of angioplasty,the rate of successful recanalization after treatment,perioperative complications and postoperative recovery of all patients were analyzed.Residual stenosis rate after recanalization of occluded vessels was evaluated by the Warfarin-Aspirin Symptomatic Intracranial Disease(WASID)study and stenosis rate>70%was considered as severe stenosis.The modified thrombolytic in cerebral infarction(mTICI)was used to evaluate the recanalization(successful recanalization,mTICI 2b-3).The effectiveness of endovascular therapy was evaluated by modified Rankin scale(mRS)3 months postoperatively.Favorable prognosis was defined as mRS 0-2,unfavorable prognosis as mRS 3-5,and death as mRS 6.Operative complications included guidewire or catheter-induced vascular perforation,balloon dilation induced vascular rupture,intraoperative thrombosis,intraoperative vascular dissection,and symptomatic intracranial hemorrhage.Symptomatic intracranial hemorrhage was defined as an increase of more than 4 points in NIHSS score within 48 hours after surgery according to the Heidelberg Bleeding Classification.Results All 25 patients received aspiration,of which 14 cases(56.0%)recovered the positive blood flow after aspiration,indicating sever stenosis(stenosis rate>70%);balloon

关 键 词：动脉闭塞性疾病 血栓切除术 血管成形术 球囊扩张 支架置入 颅内动脉粥样硬化性闭塞 

分 类 号：R651.12[医药卫生—外科学]