血管内治疗颈内动脉颅外段伴同侧颅内动脉急性串联闭塞  

Endovascular treatment for acute tandem occlusions of internal carotid artery extracranial segment and ipsilateral intracranial artery

作　　者：张东焕 刘义锋[1] 张保朝[1] 高军 康梅娟[1] 汪宁[1] 孙军[1] 王洁[1] 高毅[2] 温昌明[1] ZHANG Donghuan;LIU Yifeng;ZHANG Baochao;GAO Jun;KANG Meijuan;WANG Ning;SUN Jun;WANG Jie;GAO Yi;WEN Changming(Department of Neurology,Nanyang Municipal Central Hospital,Nanyang,Henan Province 473009,China)

机构地区：[1]南阳市中心医院神经内科,河南473009 [2]南阳市中心医院麻醉科,河南473009

出　　处：《介入放射学杂志》2022年第1期78-82,共5页Journal of Interventional Radiology

基　　金：河南省医学科技重点攻关项目(202102310079、192102310349)。

摘　　要：目的探讨颈内动脉颅外段伴同侧颅内动脉急性串联闭塞患者血管内治疗方法,评估其疗效和安全性。方法回顾性分析2015年1月至2019年12月在南阳市中心医院接受血管内治疗的63例颈内动脉颅外段伴同侧颅内动脉急性串联闭塞患者临床资料。根据治疗方式不同,分为顺行再通组(n=41)和逆行再通组(n=22)。采用改良溶栓治疗脑梗死(mTICI)血流分级判断术后血管再通程度,改良Rankin量表(mRS)评分评估术后90 d临床预后。结果两组患者年龄、性别、伴高血压病、伴糖尿病、伴心房颤动、吸烟史、术前美国国立卫生研究院卒中量表(NIHSS)评分、术前Alberta卒中项目早期CT评分(ASPECTS)、脑卒中病因等差异均无统计学意义(均P>0.05)。顺行再通组、逆行再通组分别有16例(39.0%)、15例(68.2%)接受急诊颈内动脉起始段支架植入(P=0.027),穿刺至再通时间分别为(138+55)min、(120+47)min(P<0.01),90 d恢复良好(mRS评分≤2分)分别有17例(41.5%)、15例(68.2%)(P=0.043),差异均有统计学意义。结论血管内逆行再通治疗颈内动脉颅外段伴同侧颅内大血管急性串联闭塞,是一种安全有效的治疗选择。Objective To discuss the endovascular management strategy for acute tandem occlusions of internal carotid artery extracranial segment and ipsilateral intracranial artery,and to evaluate its curative effect and safety.Methods The clinical data of 63 patients with acute tandem occlusions of internal carotid artery extracranial segment and ipsilateral intracranial artery,who received endovascular treatment at the Nanyang Municipal Central Hospital of China between January 2015 and December 2019,were retrospectively analyzed.Based on the treatment method,the patients were divided into anterograde recanalization group(n=41)and retrograde recanalization group(n=22).Modified Thrombolysis in Cerebral Infarction(mTICI)score was used to evaluate the postoperative vascular recanalization,and modified Rankin scale(mRS)score was used to evaluate postoperative 90-day clinical prognosis.Results There was no statistically significant differences in age,gender,coexisting hypertension,diabetes,atrial fibrillation,smoking,preoperative National Institutes of Health Stroke Scale(NIHSS)score,preoperative Alberta stroke program early CT score(ASPECTS)and cause of stroke between the two groups(P>0.05).In the anterograde recanalization group and retrograde recanalization group,emergency stent implantation in the initial segment of internal carotid artery was carried out in 16 patients(39.0%)and 15 patients(68.2%)respectively(P=0.027),the time from puncturing to achieving recanalization was(138±55)min and(120±47)min respectively(P<0.01),and satisfactory postoperative 90-day good recovery(mRS score≤2 points)was obtained in 17 patients(41.5%)and 15 patients(68.2%)respectively(P=0.043);the differences in the above items between the two groups were statistically significant.Conclusion For the treatment of acute tandem occlusions of internal carotid artery extracranial segment and ipsilateral intracranial artery,endovascular retrograde recanalization is a safe and effective method.

关 键 词：颈内动脉 串联闭塞 机械取栓 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]