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| 颅内动脉机械取栓联合颈动脉支架植入治疗颈内动脉串联病变所致急性缺血性脑卒中的疗效分析 |
| 蒋群龙,张萌,尹腾昆,郝继恒,刘超,林凯,刘卫东,崔庆轲,王继跃,张利勇* |
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(聊城市人民医院脑科医院神经外科, 聊城 252000
*通信作者) |
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| 摘要: |
| 目的 评价颅内动脉机械取栓联合颈动脉支架植入治疗颈内动脉串联病变所致急性缺血性脑卒中的疗效及安全性。方法 回顾性纳入2019年1月至2020年12月在聊城市人民医院脑科医院神经外科就诊的颈内动脉串联病变所致急性缺血性脑卒中患者55例，其中采取先行颅内动脉闭塞处机械取栓、后行颈内动脉起始部重度狭窄或闭塞段支架植入手术策略的患者43例（由远及近组），采用先行颈内动脉起始部重度狭窄或闭塞段支架植入、后行颅内动脉闭塞处机械取栓手术策略的患者12例（由近及远组）。比较两组患者发病至股动脉穿刺时间，入院时、术后24 h、术后7 d美国国立卫生研究院卒中量表（NIHSS）评分，术中1次取栓成功率，股动脉穿刺至血管再通时间，术后即刻血管成功再通（改良脑梗死溶栓分级≥2b级）率，术后症状性颅内出血发生率，以及术后90 d预后良好（改良Rankin量表评分≤2分）率、死亡率。结果 55例患者均顺利完成颅内动脉闭塞处机械取栓及颈内动脉起始部重度狭窄或闭塞段支架植入术。由远及近组患者1次取栓成功率高于由近及远组[67.4%（29/43） vs 33.3%（4/12）]，股动脉穿刺至血管再通时间短于由近及远组[（68.77±17.65） min vs （100.08±38.38） min]，差异均有统计学意义（P均< 0.05）。两组患者发病至股动脉穿刺时间，入院时、术后24 h、术后7 d NIHSS评分，术后即刻血管成功再通率，术后症状性颅内出血发生率，以及术后90 d预后良好率和死亡率差异均无统计学意义（P均>0.05）。结论 颅内动脉机械取栓同期颈动脉支架植入治疗颈内动脉串联病变所致急性缺血性脑卒中是安全、有效的，但采取由远及近的手术策略比由近及远手术策略有更高的1次取栓成功率且能更快地达到血管再通。 |
| 关键词: 急性缺血性脑卒中 颈动脉串联病变 机械取栓术 颈动脉支架植入 |
| DOI：10.16781/j.0258-879x.2022.01.0080 |
| 投稿时间：2021-09-21 |
| 基金项目: |
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| Mechanical thrombectomy of intracranial artery combined with carotid stent implantation in treatment of acute ischemic stroke caused by tandem lesions of internal carotid artery: an analysis of efficacy |
| JIANG Qun-long,ZHANG Meng,YIN Teng-kun,HAO Ji-heng,LIU Chao,LIN Kai,LIU Wei-dong,CUI Qing-ke,WANG Ji-yue,ZHANG Li-yong* |
(Department of Neurosurgery, Liaocheng People's Hospital (Brain Hospital), Liaocheng 252000, Shandong, China
*Corresponding author) |
| Abstract: |
| Objective To evaluate the efficacy and safety of mechanical thrombectomy of intracranial artery combined with carotid stent implantation in the treatment of acute ischemic stroke caused by tandem lesions of internal carotid artery.Methods A total of 55 patients with acute ischemic stroke caused by tandem lesions of internal carotid artery treated in Department of Neurosurgery of Liaocheng People's Hospital (Brain Hospital) from Jan. 2019 to Dec. 2020 were retrospectively included. Among them, 43 patients (distal-to-proximal group) were treated with mechanical thrombectomy for the occluded lesion of intracranial artery, followed by stent implantation for the severe stenotic/occluded lesions of initial internal carotid artery, and 12 patients (proximal-to-distal group) were treated with stent implantation for the severe stenotic/occluded lesions of initial internal carotid artery, followed by mechanical thrombectomy for the occluded lesion of intracranial artery. Onset-to-puncture time, National Institutes of Health stroke scale (NIHSS) scores on admission, and 24 h and 7 d after operation, the success rate of 1-time thrombectomy during operation, puncture-to-recanalization time, rate of successful recanalization immediately after operation (modified thrombolysis in cerebral infarction grade ≥ 2b), incidence of postoperative symptomatic intracranial hemorrhage, and good prognosis (modified Rankin scale score ≤ 2) rate and mortality 90 d after operation were compared between the 2 groups.Results All patients successfully received mechanical thrombectomy of intracranial artery and stent implantation of initial internal carotid artery. The success rate of 1-time thrombectomy in the distal-to-proximal group was significantly higher than that in the proximal-to-distal group (67.4%[29/43] vs 33.3%[4/12], P < 0.05), and the puncture-to-recanalization time was significantly shorter than that in the proximal-to-distal group ([68.77±17.65] min vs[100.08±38.38] min, P < 0.05). There were no significant differences in the onset-to-puncture time, NIHSS scores on admission, 24 h and 7 d after operation, successful recanalization rate immediately after operation, incidence of postoperative symptomatic intracranial hemorrhage, or good prognosis rate and mortality 90 d after operation between the 2 groups (all P>0.05).Conclusion Mechanical thrombectomy of intracranial artery combined with carotid stent implantation is safe and effective in the treatment of acute ischemic stroke caused by tandem lesions of internal carotid artery. The distal-to-proximal strategy has a higher success rate of 1-time thrombectomy than the proximal-to-distal strategy, and can achieve successful recanalization much faster. |
| Key words: acute ischemic stroke carotid artery tandem lesions mechanical thrombectomy carotid artery stent implantation |
