急性缺血性脑卒中血管内治疗21例临床分析

Endovascular treatment of acute ischemic stroke: A clinical analysis of 21 cases

摘要:

目的 探讨急性缺血性脑卒中血管内治疗的方法、疗效和安全性。方法 回顾性分析血管内治疗的大血管闭塞的急性缺血性脑卒中患者21例。10例为阿替普酶静脉溶栓后桥接血管内治疗，11例直接行血管内治疗。其中机械取栓12例，机械取栓+支架植入3例，单纯颈动脉支架植入3例，机械取栓+动脉溶栓1例，机械取栓+动脉溶栓+支架植入1例，单纯动脉溶栓1例。评估术中mTICI再通等级、并发症及术后随访第90天mRS评分，分析疗效与安全性。结果 21例患者前循环卒中18例，后循环卒中3例。NIHSS评分平均15.81±6.44分。20例患者术后血管再通达mTICI 2b-3级。术中并发出血1例，术后大量颅内出血1例，无症状少量颅内出血4例。术后高灌注综合征8例，其中4例行去骨瓣减压术，最终死亡5例（23.81%）。术后随访第90天mRS评分0～2分8例。结论 经充分评估并及时采取适宜的单一或多种血管内治疗方法对于大血管闭塞导致的急性缺血性脑卒中患者安全有效。

Abstract:

Objective To investigate the effectiveness and safety of endovascular therapies in patients with acute ischemic stroke (AIS).Methods Twenty-one cases were reviewed who had AIS caused by large vessel occlusion and underwent endovascular treatment. Ten cases underwent endovascular therapy after intravenous thrombolysis with alteplase, and 11 cases were treated with direct endovascular therapy. Twelve of the 21 patients were treated with mechanical thrombectomy, three with mechanical thrombectomy combined with stent implantation, three with carotid artery stenting, one with mechanical thrombectomy and intra-arterial thrombolysis, one with mechanical thrombectomy combined with stent implantation and intra-arterial thrombolysis, and one with intra-arterial thrombolysis. The effectiveness and safety were assessed based on intraoperative recanalization status according to the modified Thrombolysis in Cerebral Infarction (mTICI) scale, complications, and the modified Rankin Scale (mRS) score 90 days after operation.Results Among the 21 patients, 18 had anterior circulation stroke, and three had posterior circulation stroke. The mean National Institutes of Health Stroke Scale score was 15.81±6.44. Recanalization (mTICI 2b-3) was achieved in 20 patients. There was one case of intraoperative hemorrhage; after operation, one case suffered massive intracranial hemorrhage, and four cases had asymptomatic mild intracranial hemorrhage; eight cases were affected by postoperative hyperperfusion syndrome, four of whom underwent decompressive craniectomy and five (23.81%) died. Eight patients got a mRS score of 0~2 at 90 days after operation.Conclusions It is safe and effective to take timely and suitable single or multiple endovascular therapies based on careful evaluation in patients with AIS caused by large vessel occlusion.