大脑中动脉狭窄所致豆纹动脉供血区低灌注性脑梗死介入治疗的初步探索  

Preliminary exploration of endovascular treatment for cerebral infarction caused by middle cerebral artery stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery

作　　者：王子尧 魏森[1] 付晓杰 刘朝[1] 雷丽敏 袁永杰 徐浩文[1] 郭新宾[1] 管生[1] Wang Ziyao;Wei Sen;Fu Xiaojie;Liu Chao;Lei Limin;Yuan Yongjie;Xu Haowen;Guo Xinbin;Guan Sheng(Department of Interventional Neurology,the First Affiliated Hospital of Zhengzhou University,Henan Provincial Neurointerventional Engineering Research Center,Zhengzhou 450052,China;Department of Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院神经介入科,河南省神经介入工程研究中心,郑州450052 [2]郑州大学第一附属医院放射科,郑州450052

出　　处：《中华神经科杂志》2023年第5期513-520,共8页Chinese Journal of Neurology

摘　　要：目的探究大脑中动脉(MCA)狭窄所致豆纹动脉供血区低灌注性脑梗死患者行介入治疗的必要性、安全性和有效性。方法回顾性收集2014年1月至2021年10月于郑州大学第一附属医院行介入治疗的MCA粥样硬化性疾病患者的临床及手术资料,从中筛选出符合因MCA狭窄所致豆纹动脉供血区低灌注性脑梗死病例共6例,总结并分析该6例患者的手术前后临床影像学特征、围手术期并发症情况以及随访情况。结果 6例患者介入治疗术后的豆纹动脉显影均较术前显影清晰,其中2例患者术后豆纹动脉主干显影数量较术前增多,术后CT灌注成像显示豆纹动脉供血区灌注较术前均得到明显改善。6例患者在围手术期均无卒中、短暂性脑缺血发作(TIA)及死亡。患者的随访时间为360(322,495)d,所有患者在随访期间均无靶血管责任供血区域卒中、TIA及死亡。影像学随访中有3例患者行数字减影血管造影检查,3例行CT血管造影检查,均显示靶血管管腔通畅。结论经过严格影像学评估后的MCA狭窄所致豆纹动脉供血区低灌注性脑梗死患者,行介入治疗可能是有效并且安全的。Objective To evaluate the necessity,safety and efficacy of endovascular treatment for cerebral infarction caused by middle cerebral artery(MCA)stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery.Methods The clinical and surgical data of patients with MCA atherosclerotic disease who underwent endovascular treatment in the First Affiliated Hospital of Zhengzhou University from January 2014 to October 2021 were retrospectively analyzed.A total of 6 patients with cerebral infarction caused by MCA stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery were selected.The preoperative and postoperative clinical imaging characteristics,perioperative complications and follow-up of these 6 patients were summarized and evaluated.Results After the endovascular treatment,the imaging of the lenticulostriate artery in all the 6 patients was clearer than that before the operation,and the number of main trunks of the lenticulostriate artery shown by imaging in 2 patients was more than that before operation.The computer tomography perfusion of 6 patients after the endovascular treatment showed that perfusion in the supply area of the lenticulostriate artery was significantly improved compared with pre-operation.No stroke,transient ischemic attack(TIA)and death occurred during the perioperative period.The time of clinical follow-up was 360(322,495)days,and there were no stroke,TIA or death occurring in the corresponding artery.All the 6 patients underwent imaging follow-up,of which 3 patients underwent digital subtraction angiography and 3 underwent CT angiography.The lumen of the target vessels showed patency in all patients.Conclusions With rigorous imaging evaluation,endovascular treatment may be safe and effective for cerebral infarction caused by MCA stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery.

关 键 词：颅内动脉疾病 动脉粥样硬化 脑梗死 介入治疗 磁共振成像 数字减影血管造影术 灌注成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学]