Enterprise 2支架置入在动脉粥样硬化性急性大脑中动脉闭塞血管内再通治疗中的效果分析  

Analysis of the effectiveness of Enterprise 2 stent implantation in the endovascular recanalization treatment of acute atherosclerotic middle cerebral artery occlusion

作　　者：刘俊中 时伟玉 毛立武 王天玉 谢晓晓 杨硕 Liu Junzhong;Shi Weiyu;Mao Liwu;Wang Tianyu;Xie Xiaoxiao;Yang Shuo(Department of Neurointervention,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学附属郑州中心医院神经介入科,郑州450000

出　　处：《中华神经外科杂志》2024年第8期797-803,共7页Chinese Journal of Neurosurgery

基　　金：河南省医学科技攻关计划(LHGJ20220857)。

摘　　要：目的探讨Enterprise 2支架置入在动脉粥样硬化性急性大脑中动脉闭塞血管内再通治疗中的安全性和有效性。方法回顾性分析2019年1月至2022年12月郑州大学附属郑州中心医院神经介入科收治的71例动脉粥样硬化性急性大脑中动脉闭塞所致急性缺血性卒中(AIS)患者的临床资料。其中46例患者行球囊扩张联合Enterprise 2支架置入(支架置入组),25例患者行单纯球囊扩张术(球囊扩张组)。以改良脑梗死溶栓(mTICI)分级评估术后血管再通程度(mTICI≥2b级为血管成功再通);记录围手术期并发症,采用美国国立卫生研究院卒中量表(NIHSS)评估患者术后7 d的神经功能[NIHSS评分较术前降低≥4分为神经功能改善]、以改良Rankin量表评分(mRS)评估患者术后90 d时的预后[mRS≤2分为预后良好];通过影像学评估随访期间有无血管再狭窄,并比较两组间的差异。结果71例患者均达到血管成功再通。支架置入组和球囊扩张组分别有36例、17例完成术后影像学随访,随访时间为3~12个月。两组患者的年龄、性别、脑血管病相关危险因素、是否行静脉溶栓、术前NIHSS评分、是否行机械取栓、发病至股动脉穿刺时间、手术时长的差异均无统计学意义(均P>0.05)。与球囊扩张组相比,支架置入组的围手术期远端血管栓塞率[分别为4.3%(2/46)和20.0%(5/25)]、随访期支架内再狭窄的发生比例(分别为4/36和6/17)更低(均P<0.05)。两组即刻血管成功再通程度、术后即刻残余狭窄率、术后1周内症状性颅内出血和死亡的发生率、术后1周神经功能改善率、术后90 d预后良好比例的差异均无统计学意义(均P>0.05)。结论对于动脉粥样硬化性急性大脑中动脉闭塞所致的AIS患者,应用Enterprise 2支架置入的疗效可能优于单纯球囊扩张术,且并发症更少。Objective To explore the safety and effectiveness of Enterprise 2 stent implantation in the endovascular recanalization treatment of atherosclerotic acute middle cerebral artery(MCA)occlusion.Methods A retrospective analysis was performed on the clinical data of 71 patients with acute ischemic stroke(AIS)caused by atherosclerotic acute MCA occlusion who were admitted to the Neurointerventional Department of Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2019 to December 2022.Among them,46 patients underwent balloon dilation combined with Enterprise 2 stent implantation(stent implantation group),and 25 patients underwent balloon dilation alone(balloon dilation group).The modified Thrombolysis in Cerebral Infarction(mTICI)grade was used to evaluate the degree of postoperative vascular recanalization(mTICI≥grade 2b indicated successful recanalization).Perioperative complications were documented,and the National Institute of Health Stroke Scale(NIHSS)was used to evaluate patients.Neurological function on the 7th day after surgery(NIHSS≥4 points as compared with pre-operation was considered neurological improvement),and modified Rankin scale score(mRS)was used to evaluate the patient′s outcome on the 90th day after surgery(mRS≤2 points indicated good outcome).The presence or absence of vascular restenosis during the follow-up period was assessed by imaging,and the differences between the two groups were compared.Results All 71 patients achieved successful recanalization of blood vessels.Thirty-six cases in the stent implantation group and 17 cases in the balloon dilation group were followed up,and the follow-up time ranged from 3 to 12 months.There were no statistically significant differences between the two groups of patients in terms of age,gender,risk factors related to cerebrovascular disease,whether intravenous thrombolysis was performed,preoperative NIHSS score,whether mechanical thrombectomy was performed,time from onset to femoral artery puncture,or operation duration(all P

关 键 词：动脉闭塞性疾病 卒中 大脑中动脉 血管内操作 治疗结果 Enterprise 2支架 

分 类 号：R743[医药卫生—神经病学与精神病学]