优化救治流程与Solitaire FR支架在治疗急性脑动脉闭塞中的应用

doi:10.6040/j.issn.1671-7554.0.2017.156

摘要/Abstract

摘要： 目的探讨在优化救治流程中,应用支架取栓的方法治疗急性脑动脉闭塞(ACAO)的效果及安全性。方法回顾2013年1月至2016年12月进入优化救治流程中应用Solitaire FR支架取栓方法治疗的36例ACAO患者,血管再通标准采用mTICI分级,临床效果及预后采用美国国立卫生研究院卒中量表(NIHSS)评分,以及90 d改良Rankin评分(mRS)评价其疗效及安全性。结果 33例患者经血管内治疗后均成功开通闭塞血管(mTICI 2b-3),2例患者经治疗后血管部分再通(mTICI 2a),1例患者仅有微量血流通过闭塞段(mTICI 1)。术前及术后NIHSS评分相比,差异有统计学意义(P<0.05)。术后90 d改良Rankin评分(mRS)显示预后良好。其中0分5例,1分24例,2分4例,1例失访,2例死亡。33例患者随访期内复查无血管再闭塞,无症状性脑出血并发症。结论应用机械取栓治疗ACAO是安全、有效的,但应严格把握适应证及禁忌证。

关键词: 机械取栓, 疗效, 急性脑动脉闭塞, 大血管闭塞, 血管内治疗

Abstract: Objective To explore the effectiveness and safety of Solitaire FR stent in the optimized treatment of acute cerebral artery occlusion(ACAO). Methods Data of 36 ACAO cases treated with Solitaire FR stent mechanical thrombectomy during Jan. 2013 and Dec. 2016 were retrospectively analyzed. The recanalization rate was assessed with mTICI score, the clinical outcome was evaluated with NIHSS score, and the clinical efficacy and safety were determined with modified Rankin Score(mRS). Results Altogether 33 patients achieved successful recanalization(TICI 2b-3), 2 patients had partial recanalization(mTICI 2a), and 1 patient had slight recanalization(mTICI 1). The NIHSS score was significantly lower after operation(P<0.05). The 90-day mRS indicated satisfactory prognosis. The mRS was 0 in 5 patients, 1 in 24 patients, and 2 in 4 patients. One patient was loss of follow-up, and 2 patients died during the follow-up. No vessel occlusion or asymptomatic cerebral hemorrhage were observed in the other 33 patients. 山东大学学报 (医学版)55卷7期 -颜进项,等.优化救治流程与Solitaire FR支架在治疗急性脑动脉闭塞中的应用 \=- Conclusion Endovascular therapy of acute cerebral artery occlusion is safe and effective, but the indications and contraindications should be strictly observed.

Key words: Endovascular therapy, Mechanical thrombectomy, Efficacy, Acute cerebral artery occlusion, Large vessel occlusion

中图分类号:

R743.3

颜进项,孟雷,董亚南,张爱军,岳洪胜,李波,钟良君,白爱国. 优化救治流程与Solitaire FR支架在治疗急性脑动脉闭塞中的应用[J]. 山东大学学报（医学版）, 2017, 55(7): 49-54.

YAN Jinxiang, MENG Lei, DONG Yanan, ZHANG Aijun, YUE Hongsheng, LI Bo, ZHONG Liangjun, BAI Aiguo. Application of Solitaire FR stent in the optimized treatment of acute cerebral artery occlusion[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(7): 49-54.

参考文献

[1] Papanagiotou P, White CJ. Endovascular reperfusion strategies for acute stroke[J]. JACC Cardiovasc Interv, 2016, 9(4): 307-317.
[2] 王忠诚. 神经外科学[M]. 武汉: 湖北科学技术出版社, 2005: 809.
[3] Cherian L, Cutting S, Song S. Intra-arterial thrombectomy: does invasive treatment lead to better outcomes than intravenous thrombolysis alone?[J]. Curr Cardiol Rep, 2015, 17(10): 82. doi:10.1007/s11886-015-0639-z.
[4] Saqqur M, Uchino K, Demchuk AM, et al. Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke[J]. Sroke, 2007, 38(3): 948-954.
[5] Kim YS, Garami Z, Mikulik R, et al. Early recanalization rates and clinical outcomes in patients with tandem internal carotid artery/middle cerebral artery occlusion and isolated middle cerebral artery occlusion[J]. Stroke, 2005, 36(4): 869-871.
[6] Rha JH, Saver JL. The impact of recanalization on ischemics stroke outcome: a meta-analysis[J]. Stroke, 2007, 38(3): 967-973.
[7] Saver JL, Jahan R, Levy EI, et al. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischemic stroke(SWIFT): a randomised, paralled-group, non-inferiority trial[J]. Lancet, 2012, 380(9849): 1241-1249.
[8] Singh P, Doostkam S, Reinhard M, et al. Immunohistochemical analysis of thrombi retrieved during treatment of acute ischemic stroke: Does stent-retriever cause intimal damage?[J]. Stroke, 2013, 44(6): 1720-1722.
[9] Ribo M, Molina CA, Jankowitz B, et al. Stenttrievers versus other endovascular treatment methods for acute stroke: comparison of procedural results and their relationship to outcomes[J]. Journal of Neurointervention Surgery, 2014, 6(4): 265-269.
[10] Campbell BC, Hill MD, Rubiera M, et al. Safety and Efficacy of Solitaire Stent Thrombectomy Individual Patient Data Meta-Analysis of Randomized Trials[J]. Stroke, 2016, 47(3): 798-806.
[11] Ma J, Shui S, Han X, et al. Mechanical thrombectomy with Solitaire AB stents for the treatment of intracranial venous sinus thrombosis[J]. Acta Radiol, 2016, 57(12):1524-1530.
[12] Mullen M. Intra-arterial thrombectomy improves functional outcome when administered up to 6h after stroke[J]. Evid Based Med, 2015, 20(6): 209. doi: 10.1136/ebmed-2015-110187.
[13] 陈苏毅. 介入技术治疗缺血性脑血管疾病的临床研究[D]. 合肥:安徽医科大学, 2012.
[14] 李远志. 缺血性脑血管病介入治疗的临床研究[D]. 广州:南方医科大学, 2014.
[15] 邹蓉, 曲晓宁, 周艳玲, 等. 介入技术治疗缺血性脑血管疾病的疗效观察[J]. 湖南师范大学学报(医学版), 2015, 3: 62-64. ZOU Rong, QU Xiaoning, ZHOU Yanling, et al. Observation of curative effect of interventional techniques in the treatment of ischemic cerebral vascular disease[J]. J Hunan Normal Univ(Med Sci), 2015, 3: 62-64.
[16] 卫杰, 耿昌明, 韦道明, 等.介入技术治疗缺血性脑血管疾病49例疗效观察[J]. 海军医学杂志, 2016, 1: 47-50. WEI Jie, GENG Changming, WEI Daoming, et al. Observation on the clinical value of intervention therapy in the treatment of 49 cases of ICVD[J]. Journal of Navy Medicine, 2016, 1: 47-50.
[17] 刘婉婷, 许治强, 关海涛, 等. 缺血性脑血管病介入手术治疗的回顾性分析[J]. 中国现代手术学杂志, 2014, 3: 215-218. LIU Wanting, XU Zhiqiang, GUAN Haitao, et al. A retrospective analysis of interventional treatment of ischemic cerebrovascular diseases[J]. Chinese Journal of Modern Operative Surgery, 2014, 3: 215-218.
[18] 李立恒. 机械碎栓与支架取栓结合动脉内溶栓治疗急性脑动脉闭塞的临床研究[D]. 广州:南方医科大学, 2014.
[19] Haussen DC, Jadhav A, Jovin T, et al. Endovascular management vs intravenous thrombolysis for acute stroke secondary to carotid artery dissection: local experience and systematic review[J]. Neurosurgery, 2016, 78(5): 709-716.
[20] Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke[J]. N Engl J Med, 2015, 372(1): 11-20.
[21] Reuben Grech, Adrian Mizzi, Richard Pullicino, et al. Functional outcomes and recanalization rates of stent retrievers in acute ischaemic stroke: A systematic review and meta-analysis[J]. The Neuroradiology Journal, 2015, 28(2): 152-171.
[22] Hong KS, Ko SB, Lee JS, et al. Endovascular recanalization therapy in acute ischemic stroke: updated meta-analysis of randomized controlled trials[J]. Stroke, 2015, 17(3): 268-81.
[23] Mdaelil TP, Kansagra AP, Cross DT, et al. Mechanical thrombetomy in pediatric acute ischemic stroke: clinical outcomes and literature review[J]. Interv Neuroradiol, 2016,22(4):426-431.
[24] 中华预防医学会卒中预防与控制专业委员会介入学组,急性缺血性脑卒中血管内治疗中国专家共识组. 急性缺血性脑卒中血管内治疗中国专家共识[J].中国脑血管病杂志, 2014, 10: 556-560.
[25] Ozdemir O, Giray S, Arlier Z, et al. Predictors of a good outcome after endovascular stroke treatment with stent retrievers[J]. Scientific World Journal, 2015,2015: 403726. doi: 10.1155/2015/403726.

相关文章 15

[1]	底学敏,牛书雷,赵静,杜随,于慧敏,张宏涛,王娟. CT引导下¹²⁵I粒子植入治疗晚期胃癌淋巴结转移[J]. 山东大学学报（医学版）, 2017, 55(9): 79-84.
[2]	赵文博,甄长青,袁代,单宁宁,王娜,封丽丽,李沛沛,丁梅,李英,张凌岩,王欣. 膦甲酸钠治疗血液病患者合并EB病毒感染的临床疗效[J]. 山东大学学报（医学版）, 2017, 55(9): 96-99.
[3]	刘松涛,沈斌,林辉,李香伟,温昭科. 全胸腔镜下心脏不停跳与停跳二尖瓣置换术的对比[J]. 山东大学学报（医学版）, 2016, 54(8): 39-43.
[4]	王军锋,刘倩,孙小刚,李金良,徐加龙,吕其刚,马楠,王若义. 门静脉左支血管转流术治疗小儿门静脉海绵样变性的疗效评估[J]. 山东大学学报（医学版）, 2016, 54(7): 28-32.
[5]	徐闯,戚大春,李贤让,祖萌,李健,刘明廷. 初次髋关节置换术后引流与否的Meta分析[J]. 山东大学学报（医学版）, 2016, 54(6): 43-49.
[6]	张斌,张良文,迟令懿,王传伟,朱树干. 显微血管减压术治疗原发性三叉神经痛疗效的相关因素[J]. 山东大学学报（医学版）, 2016, 54(6): 69-72.
[7]	张明明,安永辉,韩彩莉,张瑛琪,马明,李娜,邹长鹏. CIK细胞联合光动力治疗中晚期食管癌的疗效观察[J]. 山东大学学报（医学版）, 2016, 54(1): 38-41.
[8]	王玉琴, 哈秀英, 徐卫国. 三种抗精神分裂症药物的疗效和经济学评价[J]. 山东大学学报（医学版）, 2014, 52(Z2): 196-197.
[9]	闫文明, 王宏伟. 鼻咽癌同步放化疗的远期疗效分析[J]. 山东大学学报（医学版）, 2014, 52(S2): 91-91.
[10]	刘怡. 替罗非班联合IABP对冠脉复杂病变患者PCI术后的近期疗效观察[J]. 山东大学学报（医学版）, 2014, 52(11): 45-48.
[11]	樊庆凯, 龚维明, 宁斌, 宋宏亮, 蔚建鲁, 贾堂宏. PKP治疗骨质疏松性多节段椎体压缩性骨折的临床疗效[J]. 山东大学学报（医学版）, 2014, 52(11): 73-76.
[12]	鞠盛涛, 贾堂宏, 宁斌. 髋臼周围截骨术治疗成人髋关节发育不良的疗效[J]. 山东大学学报（医学版）, 2014, 52(10): 100-102.
[13]	王秉翔1，聂林1, 蒲华清2，张志勉2. Dynesys动态稳定系统与腰椎后路椎体间融合术术后疗效的Meta分析[J]. 山东大学学报(医学版), 2013, 51(9): 72-78.
[14]	陈澎1，王静1，张林娜2. 189例先天性上斜肌麻痹的手术效果[J]. 山东大学学报(医学版), 2013, 51(7): 84-86.
[15]	李波翰，吴东进，宋杨，张程，赵杰，李德全，张颖哲，马胜忠，高春正. 周围神经吻合后神经生长因子-纤维蛋白胶包埋的临床观察[J]. 山东大学学报(医学版), 2013, 51(7): 58-61.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed