颅外动脉狭窄不同干预方案联合机械取栓治疗前循环串联病变的再灌注效果  

The efficacy of various interventions to the extracranial stenosis on reperfusion in anterior tandem lesions receiving mechanical thrombectomy

作　　者：冯雪岩 熊云云 王利圆 曹智鑫 郝曼均 宗黎霞 王上 FENG Xueyan;XIONG Yunyun;WANG Liyuan;CAO Zhixin;HAO Manjun;ZONG Lixia;WANG Shang(Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心,北京100070

出　　处：《基础医学与临床》2024年第10期1388-1393,共6页Basic and Clinical Medicine

基　　金：2023年北京市高层次留学人才回国资助项目;北京市科学技术委员会、中关村科技园区管理委员会“AI+健康协同创新培育”专项(Z211100003521019)。

摘　　要：目的探讨前循环串联病变(TL)相关急性缺血性卒中(AIS)中,颅外动脉狭窄的不同干预方案联合机械取栓(MT)治疗的急性再灌注效果。方法多中心、横断面研究,回顾性纳入接受MT的前循环TL相关AIS患者。记录颅外动脉狭窄干预方案,使用改良脑梗死溶栓评分(mTICI)评估术后再灌注效果。血管完全再通定义为mTICI 3,血管良好再通定义为mTICI 2b/3。比较颅外段病变不同干预方案与术后再灌注的关系。结果共纳入117例患者,92.3%术后达到良好再通,63.2%术后达到完全再通。各干预方案间良好再通率无显著差异。颅外病变血管内治疗组的完全再通率显著高于保守治疗组(P<0.05),且不同血管内治疗方案间的完全再通率存在显著差异(P<0.05):急诊球囊血管成形术组(100.0%)最高,急诊支架植入组(80%)其次,急诊支架植入+球囊血管成形术组为73.7%,保守治疗组(54.3%)最低。结论颅内MT同期颅外血管内治疗有利于TL完全再通,且急诊球囊血管成形术效果可能优于急诊支架植入术。Objective To evaluate the efficacy of different interventions to the extra cranial lesions in acute ischemic stroke(AIS)due to anterior tandem lesions(TL)on reperfusion.Methods As a multi-center,cross-sectional study,AIS due to anterior TL receiving mechanical thrombectomy(MT)were retrospectively collected.Interventions to the extra-cranial stenosis were recorded.Post-procedural reperfusion was assessed using the modified thrombolysis in cerebral infarction(mTICI)score.Complete revascularization was defined as mTICI 3 and good revascularization was defined as mTICI 2b/3.The relationship between different extra-cranial intervention regimens and rate of re-vascularization was compared.Results Totally 117 patients were included with 92.3%reaching good recanalization and 63.2%reaching complete re-canalization.There was no significant difference in good re-canalization rates among various extra-cranial intervention regimens.The rate of complete re-canalization was significantly higher in patients receiving endovascular therapy(P<0.05)and there was significant difference among various endovascular treatment regimens(P<0.01):acute balloon angioplasty only group presented the highest rate of complete re-canalization(100.0%),followed by acute stenting only group(80%),acute stenting+balloon angioplasty group(73.7%)and conservative treatment group(54.3%).Conclusions Endovascular intervention to extra-cranial stenosis contributes to complete re-canalization in AIS due to anterior TL receiving MT,and acute balloon angioplasty seems to be quite effective than acute stenting.

关 键 词：急性缺血性卒中 串联病变 支架植入 球囊血管成形术 再灌注 

分 类 号：R743.3[医药卫生—神经病学与精神病学]