血管内介入治疗症状性非急性大脑中动脉闭塞的疗效  

Efficacy of intravascular intervention in the treatment of symptomatic non-acute middle cerebral artery occlusion

作　　者：刘福德 马文龙 韩香凝 李嘉豪 江世良 商静 于嘉 程娅雯 LIU Fude;MA Wenlong;HAN Xiangning;LI Jiahao;JIANG Shiliang;SHANG Jing;YU Jia;CHENGYawen(The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710000,China;Shanxi Provincial People’s Hospital,Xi’an 710068,China)

机构地区：[1]西安交通大学第一附属医院,陕西西安710000 [2]陕西省人民医院,陕西西安710068

出　　处：《中国实用神经疾病杂志》2024年第12期1453-1458,共6页Chinese Journal of Practical Nervous Diseases

基　　金：陕西省重点研发计划项目(编号:2021SF-059)。

摘　　要：目的探讨血管内介入治疗症状性非急性大脑中动脉闭塞的有效性和安全性。方法选取西安交通大学第一附属医院2019-01—2022-06收治的64例症状性非急性大脑中动脉闭塞患者进行回顾性分析,所有患者均采取血管内介入治疗。观察并记录所有患者血管成功再通率以及手术相关并发症发生情况,分析典型病例相关影像学资料,并对所有患者术后3、6、12个月进行随访,采用改良Rankin评分量表(mRS)神经功能缺损量表(NIHSS)评价患者预后情况。结果64例患者中57例血管成功再通,7例患者开通失败,血管再通时间为(4.63±0.23)d,仅采取单纯球囊扩张血管成形术的患者21例,球扩支架植入18例,自膨式支架植入25例。所有患者术中均未出现血管穿孔出血事件,2例患者术中出现动脉夹层,1例血栓逃逸并行机械取栓,2例术后出现谵妄症状,1例癫痫发作。所有患者术后30 d内均无死亡及缺血性脑卒中病例;64例患者中3例术后1 d复查CT显示左侧大脑半球肿胀,2例术后第3天复查CT显示梗死灶少量出血,2例术后3 d出现头部胀痛,1例患者术后第6天脑血管造影发现支架内血栓形成,所有患者术后短期均无死亡病例;64例患者术后3个月成功随访63例,术后6个月成功随访60例,术后12个月成功随访58例。所有患者术后3、6、12个月mRS、NIHSS评分逐渐升高,高于出院前基线数据(P<0.05)。结论血管内介入治疗症状性非急性大脑中动脉闭塞效果显著,再通率高达89.06%,且术后短期并发症发生率较低为12.50%,同时患者术后远期残疾程度较低,神经功能恢复较好。Objective To investigate the efficacy and safety of intravascular intervention in the treatment of symptomatic non-acute middle cerebral artery occlusion.Methods A retrospective analysis was conducted on 64 symptomatic non-acute middle cerebral artery occlusion patients admitted to the First Affiliated Hospital of Xi’an Jiaotong University from January 2020 to June 2022.All patients underwent endovascular intervention and recanalization treatment.The short-term vascular recanalization rate,intraoperative and postoperative complications in all patients were observed and recorded.The imaging data related to typical cases were analyzed,and all patients were followed up 3,6,and 12 months after surgery.The prognosis of patients was evaluated by the modified Rankin scale(mRS)and NIHSS.Results Among the 64 patients,57 patients had successful vascular recanalization and 7 patients failed.The vascular recanalization time was(4.63±0.23)days.There were 21 patients who only underwent balloon dilation angioplasty,18 patients with balloon stents,and 25 patients with self-expanding stents.All patients had no occurrence of arteriovenous fistula during surgery,but there were 2 patients who experienced arterial dissection during surgery,1 patient had embolus displacement and stent removal,2 patients had prolonged surgical intolerance,2 patients had delirium,and 1 patient had epilepsy.There were no deaths or ischemic stroke within 30 days after surgery in all patients.Among the 64 patients,3 patients showed swelling in the left hemisphere on CT scan 1 day after surgery,2 patients showed slight bleeding in the infarcted area on CT scan 3 days after surgery,2 patients experienced head swelling and pain 3 days after surgery,and 1 patient showed thrombosis in the stent on cerebral angiography 6 days after surgery.There were no deaths in all patients in the short-term after surgery.Among 64 patients,63 were successfully followed up 3 months after surgery,60 were successfully followed up 6 months after surgery,and 58 were successfully

关 键 词：非急性大脑中动脉闭塞 血管内介入术 再通率 安全性 神经功能 

分 类 号：R743[医药卫生—神经病学与精神病学]