双路途指导下血管内治疗症状性非急性颈内动脉颅内段闭塞的疗效观察  

Observation on the efficacy of endovascular treatment under the guidance of dual-roadmap for symptomatic non-acute intracranial occlusion of internal carotid artery

作　　者：程娅雯 韩香凝 朱宁 何彩莲 张润宁[2] 于嘉 韩建峰[1] 刘福德 Yawen Cheng;Xiangning Han;Ning Zhu;Cailian He;Running Zhang;Jia Yu;Jianfeng Han;Fude Liu(Department of Neurology,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;The Second Department of Encephalopath,The Second Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,China)

机构地区：[1]西安交通大学第一附属医院神经内科,西安710061 [2]陕西中医药大学第二附属医院脑病二科,陕西咸阳712000

出　　处：《中华脑血管病杂志（电子版）》2024年第4期330-337,共8页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：陕西省自然科学基础研究计划(2023-JC-QN-0893);陕西省重点研发计划(2021SF-059)。

摘　　要：目的探讨对于血管闭塞时间超过24 h的症状性非急性颈内动脉闭塞(SNA-ICAO)患者,在双路途技术指导下行血管内治疗(EVT)开通颈内动脉颅内段的安全性和可行性。方法回顾性连续纳入2020年1月至2023年8月在西安交通大学第一附属医院及陕西中医药大学第二附属医院脑病二科住院,并在双路途技术指导下行EVT的SNA-ICAO患者为研究对象,收集患者的人口学资料及临床资料,包括基线资料、影像学资料、手术相关指标及临床预后与随访结果等,对上述资料进行描述性分析,综合评价该技术对于此类患者的安全性及有效性。结果共纳入32例患者。血管成功再通者30例(93.8%,30/32);术中发生血栓逃逸者1例(3.1%,1/32)、血管夹层者3例(9.4%,3/32),未发生任何血管穿孔出血事件;术后发生高灌注综合征者4例(12.5%,4/32),其中1例患者于术后24 h内出现症状性颅内出血;完成术后12个月影像学随访者26例,其中发生支架内再狭窄者4例(15.4%,4/26);90 d良好预后者28例(93.3%,28/30)。Ⅰ型闭塞(前交通动脉开放型)和Ⅱ型闭塞(后交通动脉开放型)患者均能获得较高的血管成功再通率(90.9%vs 95.2%)及良好预后率(90 d良好预后:81.8%vs 90.5%;12个月良好预后:72.7%vs 90.5%)。结论对于SNA-ICAO(颅内段)患者,在双路途技术指导下行EVT是安全有效的。Objective To explore the safety and feasibility of endovascular treatment(EVT)to recanalize the intracranial segment of internal carotid artery(ICA)under the guidance of dual-roadmap in patients with symptomatic non-acute internal carotid artery occlusion(SNA-ICAO)for more than 24 hours.Methods Patients with SNA-ICAO who received endovascular recanalization treatment under the guidance of dual-roadmap in the First Affiliated Hospital of Xi'an Jiaotong University and the Second Affiliated Hospital of Shaanxi University of Chinese Medicine from January 2020 to August 2023 were retrospectively included.Demographic and clinical data,including baseline data,imaging results,surgical indicators,clinical outcomes and follow-up data,were collected and a descriptive analysis of the above data was carried out to comprehensively evaluate the safety and effectiveness of this technique for such patients.Results A total of 32 patients were included.Vascular recanalization was successful in 30 cases(93.75%).Thrombus escape occurred in only one case(3.1%)and vascular dissection occurred in three cases(9.4%),without any vascular perforation or hemorrhage.Hyperperfusion syndrome occurred in four patients(12.5%),of which only 1 patient(3.1%)had symptomatic intracranial hemorrhage within 24 hours after surgery.There were 26 patients completing the imaging follow-up at 12 months postoperatively,of which 4 cases had restenosis of the stent(15.4%).After 90 days,28 cases(93.3%)had favorable prognosis.Patients with either type I or type II occlusion had a high rate of successful recanalization and a favorable prognosis.Conclusion For patients with SNA-ICAO,EVT under the guidance of dual-roadmap technique is safe and effective.

关 键 词：双路途技术 症状性非急性颈内动脉闭塞 血管内治疗 

分 类 号：R743.31[医药卫生—神经病学与精神病学]