[1]刘俊中 时伟玉 毛立武 谢晓晓 王天玉 杨硕 郭广涛.大脑中动脉急性闭塞机械取栓失败后行原位血管内成形术的疗效分析[J].卒中与神经疾病杂志,2023,30(03):249-253.[doi:10.3969/j.issn.1007-0478.2023.03.003]
　Liu Junzhong,Shi Weiyu,Mao Liwu,et al.The efficacy of in situ endovascular angioplasty after failed mechanical embolization of acute middle cerebral artery occlusion[J].Stroke and Nervous Diseases,2023,30(03):249-253.[doi:10.3969/j.issn.1007-0478.2023.03.003]
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大脑中动脉急性闭塞机械取栓失败后行原位血管内成形术的疗效分析()
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《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第30卷
期数:
2023年03期
页码:
249-253
栏目:
论著
出版日期:
2023-06-20

文章信息/Info

Title:
The efficacy of in situ endovascular angioplasty after failed mechanical embolization of acute middle cerebral artery occlusion
文章编号:
1007-0478(2023)03-0249-05
作者:
刘俊中 时伟玉 毛立武 谢晓晓 王天玉 杨硕 郭广涛
450000 郑州大学附属郑州中心医院神经介入科[刘俊中 时伟玉 毛立武 谢晓晓 王天玉(通信作者)杨硕 郭广涛]
Author(s):
Liu Junzhong;  Shi Weiyu;  Mao Liwu;  et al.
Department of Neurointervention, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450003
关键词:
大脑中动脉; 急性闭塞; 机械取栓; 血管内成形术
Keywords:
Middle cerebral artery; Acute occlusion; Mechanical thrombectomy; Endovascular angioplasty
分类号:
R743.3
DOI:
10.3969/j.issn.1007-0478.2023.03.003
文献标志码:
A
摘要:
目的 探讨大脑中动脉急性闭塞所致急性缺血性脑卒中(Acute ischemic stroke,AIS)患者机械取栓失败后行原位血管内成形术的有效性和安全性。方法 回顾性分析郑州大学附属郑州中心医院2020年5月-2021年12月的连续27例接受机械取栓失败后同期行原位血管内成形术的大脑中动脉急性闭塞所致AIS患者,记录患者的血管再通率、围手术期并发症发生率、临床预后及随访,其中19例(70.37%)患者取栓失败后同期行球囊扩张联合支架成形术(支架植入组),8例(29.63%)患者取栓失败后同期行单纯球囊扩张成形术(球囊扩张组),分析2组间差异。结果 27例(100%)患者均血管成功再通,其中采用改良脑梗死溶栓(Modified thrombolysis in cerebral infarction,mTICI)分级3级再通24例(88.9%)。27例患者血管内成形术后残余狭窄均≤50%,其中19例患者(70.4%)残余狭窄≤30%。患者股动脉穿刺至血管再通时间为103(85,145)min。围手术期2例(7.4%)患者死亡,1例(3.7%)患者出现症状性颅内出血。所有患者均未发生急性再闭塞、血管穿通出血。16例(59.3%)术后1周神经功能改善[美国国立卫生研究院卒中量表(National institutes of health stroke scale,NIHSS)评分改善较术前≥4分],19例(70.4%)患者术后90 d临床随访预后良好[改良Rankin量表(Modified Rankin scale,mRS)0～2分]。术后3～12个月影像学检查随访血管再狭窄率为22.2%(4/18),随访期间无死亡和缺血性脑卒中发生。支架植入组与球囊扩张组的预后良好率、病死率、症状性颅内出血发生率、再狭窄率均无明显差异(P>0.05); 2组术后即刻残余狭窄程度、股动脉穿刺至血管成功再通时间及随访再狭窄率有明显差异(P<0.05)。结论 对于大脑中动脉急性闭塞所致AIS患者,机械取栓失败后同期行原位血管内成形术有效且安全,球囊扩张联合支架成形术较单纯球囊扩张手术时间更长,但术后残余狭窄程度和随访再狭窄率更低。
Abstract:
ObjectiveTo investigate the efficacy and safety of in situ endovascular angioplasty after failed mechanical embolization in patients with acute ischemic stroke(AIS)caused by acute middle cerebral artery occlusion.Methods A retrospective analysis of 27 consecutive patients with AIS caused by acute middle cerebral artery occlusion who underwent in situ angioplasty after failed mechanical embolization from May 2020 to December 2021 at Zhengzhou Central Hospital, Zhengzhou University, was enrolled. Among them, 19 patients(70.37%)underwent balloon dilation combined with stenting after failed embolization(stenting group)and 8 patients(29.63%)underwent balloon dilation and stenting after failed embolization(balloon dilation group). The differences between the two groups were analyzed.Results 27 patients(100%)had successful recanalization, including 24 patients(88.9%)with mTICI grade 3 recanalization. The residual stenosis after endovascular angioplasty was ≤50% in 27 patients and the residual stenosis was ≤30% in 19 patients(70.4%). The time from femoral artery puncture to vascular recanalization was 103(85,145)minutes. During perioperative period, two patients(7.4%)died, and one patient(3.7%)had symptomatic intracranial hemorrhage. None of the patients had acute reocclusion or vascular perforation bleeding. The neurological function of 16 patients(59.3%)improved one week after operation(NIHSS score improved by ≥4 points compared with that before operation). Nineteen patients(70.4%)had a good prognosis 90 days after operation(mRS 0～2 points). The rate of vascular restenosis was 22.2%(4/18)in 3 to 12 months after operation. There was no death or ischemic stroke during the follow-up period. There was no significant difference in the prognosis rate, mortality rate, symptomatic intracranial hemorrhage rate or restenosis rate between the stent implantation group and the balloon dilation group(P>0.05). There were significant differences in the degree of residual stenosis immediately after surgery, the time from femoral artery puncture to successful recanalization and the restenosis rate between the two groups(P<0.05).Conclusion For patients with AIS caused by acute occlusion of the middle cerebral artery, it is safe to perform in situ endovascular angioplasty after failure of mechanical thrombectomy. Compared with balloon dilation, stent angioplasty requires longer operation time, but the degree of residual stenosis after operation and the restenosis rate are lower.

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备注/Memo

备注/Memo:
基金项目:河南省医学科技攻关计划项目(2018020791)
更新日期/Last Update: 2023-06-20