症状性非急性期大脑中动脉M2段闭塞血管内再通:附1例报道并文献复习  

Efficacy of endovascular recanalization for symptomatic non-acute occlusion of the M2 segment of the middle cerebral artery:a case report and literature review

作　　者：黄晨阳 刘廷钰 朱青峰 HUANG Chen-yang;LIU Ting-yu;ZHU Qing-feng(Graduate School,Shanxi Medical University,Taiyuan 030001,China;Department of Neurosurgery,Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学研究生院,太原030001 [2]山西医科大学第二医院神经外科,太原030001

出　　处：《中国临床神经外科杂志》2024年第6期341-346,共6页Chinese Journal of Clinical Neurosurgery

基　　金：山西省重点研发计划项目(社会发展方面)(201603D321061)。

摘　　要：目的探讨症状性非急性期大脑中动脉M2段闭塞的临床特征、血管内治疗的方法及其疗效。方法回顾性分析采用血管内介入治疗的1例症状性非急性期大脑中动脉M2段闭塞的临床资料,并结合相关文献进行分析。结果65岁男性,高血压病史13年余,未规律服用降血压药物;因急性脑梗死溶栓治疗后复发1周入院,左侧肢体肌力0级,NIHSS评分18分,mRS评分5分。头颅MRI示右侧大脑半球多发梗死灶,头颅CTA显示右侧大脑中动脉闭塞,脑灌注成像示右侧大脑半球明显低灌注;全脑血管造影示右侧大脑中动脉上干、下干闭塞,大脑前动脉软膜支、大脑后动脉软膜支向大脑中动脉供血区域有部分代偿。完善术前准备后,行右侧大脑中动脉上干(M2段)血管内再通治疗。术后立即复查头颅CT未见颅内出血;术后1个月,左下肢肌力5级,左上肢肌力3级,mRS评分2分。术后3年随访,左下肢肌力5级,左上肢肌力4级,mRS评分1分。结论对于大脑中动脉M2段非急性期闭塞病人,如果症状较重,在充分术前评估后,可以尝试进行血管内再通治疗。Objective To investigate the clinical features,and endovascular treatment methods and outcomes of patients with symptomatic non-acute occlusion of the M2 segment of the middle cerebral artery(MCA).Methods The clinical data of one patient with symptomatic non-acute occlusion of the M2 segment of the MCA treated with endovascular recanalization was retrospectively analyzed,and the related literatures were recovered.Results A 65-year-old male with a history of hypertension for over 13 years and no regular use of antihypertensive drugs presented with recurrent acute cerebral infarction one week after thrombolytic therapy for the initial infarction.He had a motor power of 0 on the left side,an NIHSS score of 18,and an mRS score of 5 on admission.Head MRI showed multiple infarction lesions in the right cerebral hemisphere,head CTA showed occlusion of the right MCA,and cerebral perfusion imaging showed marked hypoperfusion in the right cerebral hemisphere.The angiography showed that the superficial and deep branches of the right MCA were occluded,while the pia mater branches of the anterior and posterior cerebral arteries supplied the territory of the MCA partially.After completing preoperative evaluation,endovascular recanalization of the M2 segment of the right MCA was performed.No intracranial hemorrhage was detected on immediate postoperative head CT.One month after the operation,the left lower limb had a motor power of 5,the left upper limb had a motor power of 3,and the mRS score was 2.Three years after the operation,the left lower limb had a motor power of 5,the left upper limb had a motor power of 4,and the mRS score was 1.Conclusions For patients with non-acute occlusion of the M2 segment of the MCA associated with severe symptoms,endovascular recanalization can be considered after thorough preoperative evaluation.

关 键 词：颅内血管闭塞 大脑中动脉 非急性期 血管内治疗 疗效 

分 类 号：R743[医药卫生—神经病学与精神病学] R815.2[医药卫生—临床医学]