机械取栓治疗伴机械瓣置换的急性前循环大血管闭塞脑梗死患者有效性和安全性研究  

A study on the efficacy and safety of mechanical thrombectomy in patients with acute anterior circulation large vessel occlusion cerebral infarction with mechanical valve replacement

作　　者：杨蝶 刘振兴 张仁伟[1] 刘煜敏[1] Yang Die;Liu Zhenring;Zhang Rerwei(Department of Neurology,Zhongnan Hospital of Wuhan Universtiy,Wuhan 430071)

机构地区：[1]武汉大学中南医院神经内科,430071 [2]宜昌市夷陵人民医院神经内科

出　　处：《卒中与神经疾病》2024年第4期331-336,共6页Stroke and Nervous Diseases

摘　　要：目的探究机械取栓(Mechanical thrombectomy,MT)治疗伴机械瓣置换的前循环大血管闭塞(Large vessel occlusion,LVO)急性脑梗死(Acute ischemic stroke,AIS)患者的有效性和安全性。方法回顾性分析2019年1月-2023年6月连续18例行MT治疗伴机械瓣置换的前循环LVO-AIS患者,收集患者的人口学数据、血管危险因素、手术方式、血管再通情况、围手术期并发症及临床预后。结果18例患者中位年龄52.00(41.00,63.25)岁,11例(61.11%)为女性;18例患者的中位穿刺到首次再通时间(Procedural time,PT)为90.00(65.00,138.25)min;18例(100%)患者均达到了有效再通[改良的脑梗死溶栓分级(Modified thrombolysis in cerebral infarction,mTICI)为2b/3级];8例(44.44%)患者功能结局良好[随访术后第90 d改良Rankin量表(Modified Rankin scale,mRS)评分≤0~2分];4例(22.22%)患者术后发生症状性出血(Symptomatic intracranial hemorrhage,sICH)转化。结论在合并机械瓣置换的前循环LVO-AIS患者中行MT有助于恢复血流再灌注,能够给患者带来良好预后。Objective To explore the efficacy and safety of mechanical thrombectomy(MT)in treating patients with anterior circulation large vessel occlusion acute ischemic stroke(LVO-AIS)with mechanical valve replacement.Methods From January 2019 to June 2023,18 LVO-AIS patients after MT with mechanical valve replacement were retrospectively analyzed.Demographic data,vascular risk factors,surgical methods,vascular recanalization,perioperative complications,clinical prognosis and follow-up data were collected.Results The median age of the 18 patients was 52.00(41.00,63.25)years,and 11(61.11%)were female.The median procedural time(PT)of 18 patients was 90.00(65.00,138.25)minutes.Effective thrombolysis was achieved in18 patients(100%)[modified thrombolysis in cerebral infarction(mTICI)grade 2b/3].After90 days of follow-up,the modified Rankin scale(mRS)≤0~2 points was classified as good prognosis,and 8patients(44.44%)had good functional outcomes.Symptomatic intracranial hemorrhage(sICH)occurred in4patients(22.22%).Conclusion MT in anterior circulation LVO-AIS patients with mechanical valve replacement can help restore reperfusion and can bring good prognosis for patients.

关 键 词：机械瓣置换术 机械取栓 急性缺血性脑卒中 抗凝治疗 

分 类 号：R743.33[医药卫生—神经病学与精神病学]