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  • 杨文进,张磊,李子付,沈红健,杨鹏飞,刘建民*.大脑中动脉粥样硬化性狭窄伴急性闭塞血管成形疗效分析[J].第二军医大学学报,2020,41(2):122-128    [点击复制]
  • YANG Wen-jin,ZHANG Lei,LI Zi-fu,SHEN Hong-jian,YANG Peng-fei,LIU Jian-min*.Efficacy of angioplasty for acute atherosclerosis-related occlusion in middle cerebral artery[J].Acad J Sec Mil Med Univ,2020,41(2):122-128   [点击复制]
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大脑中动脉粥样硬化性狭窄伴急性闭塞血管成形疗效分析
杨文进,张磊,李子付,沈红健,杨鹏飞,刘建民*
0
(海军军医大学(第二军医大学)长海医院脑血管病中心, 上海 200433
*通信作者)
摘要:
目的 探讨急诊血管成形术在大脑中动脉粥样硬化性狭窄伴急性闭塞治疗中的安全性和有效性。方法 回顾性分析2013年5月至2018年8月在海军军医大学(第二军医大学)长海医院脑血管病中心接受血管内治疗的210例急性大脑中动脉闭塞缺血性卒中患者的病例资料,包括人口统计学信息和基本资料、影像学资料、治疗情况及治疗后血管再通程度[采用改良脑梗死溶栓(mTICI)再通等级评价,mTICI 2b/3级定义为成功再通]及预后与随访结果。结果 纳入患者共37例,男31例、女6例,年龄为35~81岁,平均年龄为(61.1±11.4)岁。25例患者术前行计算机断层扫描灌注成像检查并计算核心梗死区体积,其中无核心梗死区患者17例(68.0%),1~10 mL患者6例(24.0%),11~30 mL患者2例(8.0%)。大脑中动脉M1段近端1/2狭窄者22例(59.5%),M1段远端1/2狭窄者15例(40.5%)。14例(37.8%)接受桥接治疗,23例(62.2%)接受直接取栓治疗。血管成形术情况:单纯Gateway球囊扩张5例,支架成形(Apollo、Enterprise、Neuroform、Solitaire)32例。37例患者在血管成形术后残余狭窄均≤50%,其中30例(81.1%)残余狭窄≤30%,7例(18.9%)残余狭窄介于30%~50%。mTICI 2b/3级再通率为100%,其中3级再通35例(94.6%)。术中所有患者均未发生血管穿孔出血。术后1周内出现支架内再闭塞3例(8.1%);1例(2.7%)发生同侧基底节区症状性颅内出血,术后24 h NIHSS评分增加4分,3个月时改良Rankin量表评分为4分。29例患者术后3~12个月均行影像学复查,血管再狭窄率达34.5%(10/29)。结论 大脑中动脉M1段狭窄伴急性闭塞的支架取栓血管再通率高;急诊血管成形术具有良好的安全性和成功率;术后3个月预后良好率高,但偏高的血管再狭窄率不容忽视。
关键词:  大脑动脉  动脉粥样硬化性狭窄  卒中  血管成形术  预后
DOI:10.16781/j.0258-879x.2020.02.0122
投稿时间:2019-06-27修订日期:2019-09-11
基金项目:上海市卫生和计划生育委员会智慧医疗专项(2018ZHYL0218).
Efficacy of angioplasty for acute atherosclerosis-related occlusion in middle cerebral artery
YANG Wen-jin,ZHANG Lei,LI Zi-fu,SHEN Hong-jian,YANG Peng-fei,LIU Jian-min*
(Stroke Center, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding author)
Abstract:
Objective To explore the safety and efficacy of emergent angioplasty in the treatment of acute middle cerebral artery atherosclerosis-related occlusion. Methods Retrospective analysis was performed in 210 patients with acute ischemic stroke due to middle cerebral artery occlusion, who underwent arterial thrombectomy and emergent angioplasty in our hospital from May 2013 to August 2018. Demographic information, general information, imaging data, treatment, revascularization (assessed by modified thrombolysis in cerebral infarction[mTICI], mTICI 2b/3 was taken as successful recanalization), prognosis and follow-up results were evaluated. Results According to inclusion criteria, 37 patients with acute occlusion of M1 segment stenosis of the middle cerebral artery, who underwent Gateway balloon dilatation and stent implantation, were included in this study. There were 31 males and 6 females with a mean age of (61.1±11.4) years (range, 35-81 years). Computed tomography perfusion imaging was performed in 25 patients before operation, including 17 (68.0%) patients without core infarct volume, 6 (24.0%) with 1-10 mL core infarct volume and 2 (8.0%) with 11-30 mL core infarct volume. M1 lesion was located in proximal 1/2 in 22 (59.5%) patients and in distal 1/2 in 15 (40.5%) patients. Bridging technique was used in 14 (37.8%) patients and direct thrombectomy was used in 23 (62.2%) patients. Five patients were treated with Gateway balloon dilatation alone and 32 patients with stenting (Apollo, Enterprise, Neuroform, Solitaire), with a 100% technical successful rate. Residual stenosis was less than 30% in 30 (81.1%) patients, and between 30% and 50% in 7(18.9%) patients. mTICI 2b/3 recanalization rate was 100%, including 35 cases (94.6%) of grade 3 recanalization.No vascular perforation occurred. Three patients (8.1%) presented stent reocclusion within 1 week after surgery. One patient (2.7%) had symptomatic hemorrhagic transformation. National Institutes of Health stroke scale (NIHSS) increased by 4 points 24 h postoperatively, and modified Rankin scale was 4 at 3 months after surgery. The rate of vascular restenosis was 34.5% (10/29) during follow-up (3-12 months after surgery). Conclusion In acute occlusion of middle cerebral artery M1 segment stenosis, stent retriever is the first choice with a high recanalization rate. Emergent angioplasty is a safe and effective method to treat residual stenosis. Good prognosis can be achieved 3 months after surgery, but the high rate of vascular restenosis cannot be ignored.
Key words:  middle cerebral artery  atherosclerotic stenosis  stroke  angioplasty  prognosis