| 摘要: |
| 目的 探讨颅内动脉粥样硬化性狭窄（ICAS）所致大血管闭塞急性缺血性脑卒中（AIS-LVO）的血管再通技术选择和临床疗效。方法 回顾性纳入2019年1月至2021年3月在常州市第一人民医院（苏州大学附属第三医院）神经外科脑血管病中心接受血管内治疗的264例ICAS所致AIS-LVO患者，均为发病后6或8 h及以内使用机械取栓、直接抽吸、球囊扩张和/或支架植入等至少1种方式进行血管内治疗。分析患者的临床资料，包括年龄、性别、既往史、血管闭塞部位、侧支循环情况、介入治疗方式、术后即刻血管再通情况[改良脑梗死溶栓（mTICI）分级≥2b级为血管成功再通]、入院和出院时美国国立卫生研究院卒中量表（NIHSS）评分和术后90 d预后情况（改良Rankin量表评分≤2分为预后良好）。结果 264例ICAS所致AIS-LVO患者中前循环病变229例、后循环病变35例，入院时NIHSS评分分别为16（12，19）和25（22，32）分，出院时NIHSS评分别为8（6，11）和10（8，12）分。264例患者术后即刻血管成功再通率为91.3%（241/264），其中mTICI分级2b级68例（25.8%）、3级173例（65.5%）；术后24 h症状性颅内出血发生率为9.1%（24/264）；术后90 d预后良好率为55.7%（147/264），死亡率为10.6%（28/264）。132例患者接受单纯机械取栓，术后90 d预后良好率为58.3%（77/132）；108例接受机械取栓+支架补救治疗，术后90 d预后良好率为50.9%（55/108）；两组患者年龄、性别等基线资料及术后即刻血管成功再通率、术后90 d预后良好率差异均无统计学意义（P均>0.05）。结论 对于ICAS所致AIS-LVO患者，机械取栓可作为首选血管内治疗技术，且在此基础上根据患者情况选择球囊扩张、支架植入等补救措施是安全、有效的。 |
| 关键词: 急性大血管闭塞 颅内动脉粥样硬化性狭窄 缺血性脑卒中 血管内治疗 机械取栓术 血管成形术 |
| DOI：10.16781/j.0258-879x.2022.01.0065 |
| 投稿时间：2021-09-19 |
| 基金项目:常州市科学技术局科技计划项目（CE20205025） |
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| Analysis of recanalization techniques for acute large vessel occlusion caused by intracranial atherosclerotic stenosis |
| CHEN Rong-hua,CAO Jie,ZHU Xu-cheng,SHAO Hua-ming,JIANG Tian-wei,XUAN Jing-gang,PENG Ya* |
(Department of Neurosurgery, the First People's Hospital of Changzhou (the Third Affiliated Hospital of Soochow University), Changzhou 213003, Jiangsu, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the recanalization techniques for acute ischemic stroke with large vessel occlusion (AIS-LVO) caused by intracranial atherosclerotic stenosis (ICAS) and their clinical efficacy.Methods A total of 264 patients with AIS-LVO caused by ICAS who underwent endovascular treatment in Neurovascular Center, Department of Neurosurgery, the First People's Hospital of Changzhou (the Third Affiliated Hospital of Soochow University) from Jan. 2019 to Mar. 2021 were retrospectively included. All of them were treated with at least 1 method such as mechanical thrombectomy, ADAPT (a direct aspiration first-pass technique) technology, balloon dilatation and/or stent implantation within 6 or 8 h after onset. The clinical data analyzed included age, gender, past history, vessel occlusion site, collateral circulation, intervention methods, immediate postoperative recanalization (modified thrombolysis in cerebral infarction[mTICI]grade ≥ 2b indicated successful recanalization), National Institutes of Health stroke scale (NIHSS) score on admission and at discharge, and prognosis 90 d after operation (modified Rankin scale score ≤ 2 indicated good prognosis).Results Among 264 patients with AIS-LVO caused by ICAS, 229 had anterior circulation lesions and 35 had posterior circulation lesions, with NIHSS scores of 16 (12, 19) and 25 (22, 32) on admission and 8 (6, 11) and 10 (8, 12) at discharge, respectively. The immediate postoperative successful recanalization rate was 91.3% (241/264), including 68 (25.8%) patients with mTICI grade 2b and 173 (65.5%) with grade 3. The incidence of symptomatic intracranial hemorrhage 24 h after operation was 9.1% (24/264). The good prognosis rate was 55.7% (147/264) 90 d after operation, and the mortality was 10.6% (28/264). One hundred and thirty-two patients underwent mechanical thrombectomy alone and 108 patients were treated with mechanical thrombectomy+rescue stenting, and the good prognosis rates 90 d after operation were 58.3% (77/132) and 50.9% (55/108), respectively; there were no significant differences in the baseline data (such as age and gender), immediate postoperative successful recanalization rate or good prognosis rate 90 d after operation between the 2 groups (all P>0.05).Conclusion For patients with AIS-LVO caused by ICAS, mechanical thrombectomy can be the preferred endovascular treatment technique, and rescue techniques such as balloon dilatation and stent implantation are safe and effective. |
| Key words: acute large vessel occlusion intracranial atherosclerotic stenosis ischemic stroke endovascular treatment mechanical thrombectomy angioplasty |
