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  • 冯明陶,李锦,张洪剑,许奕,黄清海,刘建民,杨鹏飞*,洪波*.支架血管成形术治疗急性颅内大动脉粥样硬化性闭塞的短期疗效分析[J].第二军医大学学报,2018,39(9):1008-1012    [点击复制]
  • FENG Ming-tao,LI Jin,ZHANG Hong-jian,XU Yi,HUANG Qing-hai,LIU Jian-min,YANG Peng-fei*,HONG Bo*.Short-time therapeutic effect of stent angioplasty for acute intracranial large artery atherosclerosis occlusion[J].Acad J Sec Mil Med Univ,2018,39(9):1008-1012   [点击复制]
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支架血管成形术治疗急性颅内大动脉粥样硬化性闭塞的短期疗效分析
冯明陶,李锦,张洪剑,许奕,黄清海,刘建民,杨鹏飞*,洪波*
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 分析急诊行支架血管成形术治疗急性颅内大动脉粥样硬化性闭塞的安全性和有效性。方法 连续回顾性分析2013年5月至2018年2月于我院行动脉取栓治疗的460例急性缺血性脑卒中患者的临床资料,纳入接受支架血管成形术治疗的患者,评价支架血管成形术治疗的安全性及有效性。结果 共纳入56例患者,其中前循环36例(64.3%)、后循环20例(35.7%)。20例术前行静脉溶栓治疗,入院至静脉溶栓时间为(39.9±13.2)min。所有支架均成功释放至指定位置,技术成功率为100%(56/56)。55例(98.2%)患者实现了改良脑梗死溶栓2b、3级再通,1例患者再通失败。术后7 d美国国立卫生研究院卒中量表评分为2.0(0.0,6.0)分,较入院前[12.5(6.0,20.0)分]改善(Z=-4.073,P<0.05)。术后7例(12.5%)发生颅内出血,其中症状性颅内出血2例(3.6%)。39例(69.6%)术后3~5 d行头颅计算机断层扫描灌注成像(CTP)检查,支架通畅33例(84.6%)、再闭塞4例(10.3%)、支架内中度狭窄2例(5.1%);17例(30.4%)未行头颅CTP检查。90 d随访显示,34例(60.7%)预后良好(改良Rankin量表评分为0~2分),9例(16.1%)死亡,13例(23.2%)失访。结论 对于急性颅内大动脉粥样硬化性闭塞,急诊行支架血管成形术具有较好的安全性和有效性,但术后短期支架内再闭塞不容忽视。
关键词:  动脉粥样硬化性狭窄  血管内治疗  急性缺血性脑卒中  治疗结果
DOI:10.16781/j.0258-879x.2018.09.1008
投稿时间:2018-07-31修订日期:2018-08-29
基金项目:国家自然科学基金(81501008),上海市浦江人才计划项目(16PJD003).
Short-time therapeutic effect of stent angioplasty for acute intracranial large artery atherosclerosis occlusion
FENG Ming-tao,LI Jin,ZHANG Hong-jian,XU Yi,HUANG Qing-hai,LIU Jian-min,YANG Peng-fei*,HONG Bo*
(Stroke Center, Changhai Hospital, Navy Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding authors)
Abstract:
Objective To explore the safety and effectiveness of stent angioplasty for acute intracranial large artery atherosclerosis occlusion. Methods We retrospectively analyzed the clinical data of 460 patients with acute ischemic stroke undergoing endovascular thrombectomy in our hospital from May 2013 to Feb. 2018. We selected the patients with stent angioplasty and evaluated the safety and effectiveness. Results Fifty-six patients were included in this study, and there were 36 cases (64.3%) with occlusion of the anterior circulation and 20 cases (35.7%) of the posterior circulation. Twenty patients underwent intravenous thrombolysis before operation, and the door-to-needle time was (39.9±13.2) min. All scaffolds were successfully released to the designated location with a technical success rate of 100% (56/56). Fifty-five patients (98.2%) achieved recanalization of modified thrombolysis in cerebral infarction grade 2b and 3, and one patient had failed recanalization. The National Institutes of Health stroke scale score was 2.0 (0.0, 6.0) at 7 d after operation, which was significantly improved compared with the preoperation one (12.5[6.0, 20.0], Z=-4.073, P<0.05). Intracranial hemorrhage occurred in 7 patients (12.5%) after operation, in which 2 patients (3.6%) had symptomatic intracranial hemorrhage. Thirty-nine patients (69.6%) received skull computed tomography perfusion (CTP) examination at 3-5 d after operation, and CTP showed that 33 cases (84.6%) had patency, 4 cases (10.3%) had reocclusion, and 2 cases (5.1%) had moderate stenosis; and 17 cases (30.4%) were not examined by CTP. Thirty-four patients (60.7%) had a good prognosis at 90 d after operation (modified Rankin scale score 0-2), 9 (16.1%) died, and 13 (23.2%) were lost. Conclusion Stent angioplasty is a safe and effective treatment method for acute intracranial large artery atherosclerosis occlusion. However, short-term stent reocclusion after operation should not be ignored.
Key words:  artery atherosclerotic stenosis  endovascular treatment  acute ischemic stroke  treatment outcome