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  • 邢鹏飞,李子付,李强,赵瑞,方亦斌,赵开军,戴冬伟,杨鹏飞*,张永巍*,刘建民.支架取栓器机械取栓治疗前循环远端血管闭塞的疗效观察[J].第二军医大学学报,2018,39(9):997-1002    [点击复制]
  • XING Peng-fei,LI Zi-fu,LI Qiang,ZHAO Rui,FANG Yi-bin,ZHAO Kai-jun,DAI Dong-wei,YANG Peng-fei*,ZHANG Yong-wei*,LIU Jian-min.Efficacy of mechanical thrombectomy with stent-retriever for anterior circulation distal vessel occlusion[J].Acad J Sec Mil Med Univ,2018,39(9):997-1002   [点击复制]
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支架取栓器机械取栓治疗前循环远端血管闭塞的疗效观察
邢鹏飞,李子付,李强,赵瑞,方亦斌,赵开军,戴冬伟,杨鹏飞*,张永巍*,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 评价前循环远端血管闭塞行支架取栓器机械取栓治疗的疗效。方法 连续回顾性纳入2013年9月至2018年5月于海军军医大学(第二军医大学)长海医院脑血管病中心行支架取栓器机械取栓治疗的急性前循环远端血管闭塞患者。根据是否给予静脉溶栓治疗,将患者分为桥接组与直接取栓组。主要评价指标为支架取栓器机械取栓术后90 d改良Rankin量表(mRS)评分(mRS评分≤2分为预后良好),次要评价指标为血管成功再通率[改良脑梗死溶栓(mTICI)再通等级达2b、3级]、术后24 h美国国立卫生研究院卒中量表(NIHSS)评分、并发症及死亡率等。结果 共纳入36例(男22例)患者,年龄为26~88(68.3±13.6)岁。大脑中动脉M2段闭塞27例、大脑前动脉A1/A2段闭塞5例、大脑中动脉M2段+大脑前动脉A2段闭塞4例。远端血管闭塞行支架机械取栓术后血管成功再通率达91.7%(33/36),术后90 d预后良好率为52.8%(19/36)。血管痉挛是最常见的并发症(33.3%,12/36),其次为出血转化(16.7%,6/36)。症状性颅内出血发生率为5.6%(2/36),死亡率为8.3%(3/36)。桥接组患者14例,直接取栓组22例。桥接组术前NIHSS评分高于直接取栓组,差异有统计学意义(Z=3.025,P=0.002);而两组术后24 h NIHSS评分、取栓次数、血管成功再通率、术后90 d预后良好率、出血转化率及死亡率差异均无统计学意义(P均>0.05)。结论 前循环远端血管闭塞行支架取栓器机械取栓治疗可能是安全有效的,有利于血管再通及90 d良好预后。
关键词:  急性缺血性脑卒中  远端血管闭塞  大脑中动脉  大脑前动脉  机械取栓术  支架取栓器  改良Rankin量表
DOI:10.16781/j.0258-879x.2018.09.0997
投稿时间:2018-07-14修订日期:2018-08-23
基金项目:上海市卫生系统优秀人才培养计划(2017YQ034),上海市浦江人才计划项目(16PJD003).
Efficacy of mechanical thrombectomy with stent-retriever for anterior circulation distal vessel occlusion
XING Peng-fei,LI Zi-fu,LI Qiang,ZHAO Rui,FANG Yi-bin,ZHAO Kai-jun,DAI Dong-wei,YANG Peng-fei*,ZHANG Yong-wei*,LIU Jian-min
(Stroke Center, Changhai Hospital, Navy Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding authors)
Abstract:
Objective To explore the therapeutic effect of mechanical thrombectomy with stent-retriever for the anterior circulation distal vessel occlusion. Methods Consecutive cases with anterior circulation distal vessel occlusion treated with mechanical thrombectomy in Stroke Center of Changhai Hospital of Navy Medical University (Second Military Medical University) from Sep. 2013 to May 2018 were enrolled. According to whether undergoing intravenous thrombolysis, the patients were divided into bridging group and direct thrombectomy group. The primary outcome was the neurological functional prognosis at 90 d after operation measured with modified Rankin Scale (mRS, mRS score ≤ 2 reflected good prognosis). The secondary outcomes were the rate of recanalization (modified thrombolysis in cerebral ischemia[mTICI] grade ≥ 2b), the National Institutes of Health stroke scale (NIHSS) score at 24 h after operation, complications and mortality. Results Totally 36 patients aged (68.3±13.6) years (ranging from 26 to 88 years) were included. There were 27 cases with middle cerebral artery (MCA) M2 segment occlusion, 5 cases with anterior cerebral artery (ACA) A1/A2 segment occlusion and 4 cases with MCA M2 segment accompanied with ACA A2 segment occlusion. The rate of recanalization of the occluded distal vessels was 91.7% (33/36) after mechanical thrombectomy with stent-retriever. The rate of good prognosis at 90 d after operation was 52.8% (19/36). The most common complication was vasospasm (33.3%, 12/36), followed by hemorrhagic transformation (16.7%, 6/36). The incidence of symptomatic intracranial hemorrhage was 5.6% (2/36) and the mortality was 8.3% (3/36). There were 14 cases in the brigding group and 22 cases in the direct thrombectomy group. The preoperative NIHSS score of the bridging group was significantly higher than that of the direct thrombectomy group (Z=3.025, P=0.002). While there were no significant differences in the NIHSS score at 24 h after operation, times of thrombectomy, the rate of recanalization, the rate of good prognosis at 90 d after operation, the incidence of hemorrhagic transformation or mortality between the bridging group and the direct thrombetomy group (all P>0.05). Conclusion The mechanical thrombectomy with stent-retriever for the anterior circulation distal vessel occlusion is likely safe and effective, and it is beneficial for vascular recanalization and good outcomes at 90 d.
Key words:  acute ischemic stroke  distal vessel occlusion  middle cerebral artery  anterior cerebral artery  mechanical thrombectomy  stent-retriever  modified Rankin scale