补救性支架植入治疗急性缺血性脑卒中13例.docxVIP

补救性支架植入治疗急性缺血性脑卒中 13例 周腾飞朱良付李天晓王子亮冯光薛绛宇白卫 星李立 郑州大学人民医院(河南省人民医院)河南省介入治 疗中心 摘要： 目的探讨支架植入作为补救性措施治疗急性缺血性脑卒中的有效性与安全性。 方法回顾性分析13例大脑前循环大血管闭塞发病8 h内并接受补救性支架植入 治疗的急性缺血性脑卒中患者临床资料。所有患者治疗前均经其它再通术式(静 脉溶栓、动脉溶栓、Penumbra装置吸栓、Solitaire支架取栓)未果。根据脑梗 死溶栓(TICI)治疗后血流分级评价血管再通，记录围手术期出血及梗死并发 症。根据美国国立卫生研究院卒中量表(NTHSS)评分评价术后1周神经功能改 善情况。根据改良Rankin量表(m RS)评分评价术后3个月预后指标。结果13 例接受补救性治疗患者共植入支架16枚，支架植入前采用Solitaire可回收支 架取栓10例，Penumbra装置吸栓3例，经静脉尿激酶溶栓1例，经动脉尿激酶 溶栓1例。12例(92.3%)患者闭塞血管部分或全部再通(TICIM2B/3)。NIHSS 评分由术前平均(16. 15±5. 81)分改善为术后1周平均(8. 08±5. 61)分，差 异有统计学意义(P0. 05) o术后3个月，7例(53.8%)预后良好(m RSW2), 2例死亡。术后发生颅内出血2例，手术相关栓塞3例。结论颅内支架植入术 作为不同组合药物溶栓治疗急性缺血性脑卒中患者血管再通的补救性措施，安 全有效。 关键词： 急性脑梗死;可回收支架;机械取栓;支架植入;补救性治疗; 作者简介：李天晓 E-mail:dr. litianxiao@vip. 163. com 收稿日期:2016-08-05 Rescue stent implantation for the treatment of acute ischemic stroke: initial experience in 13 patients ZHOU Tengfei ZHU Liangfu LI Tianxiao WANG Ziliang FENG Guang XUE Jiangyu BAI Weixing LI Li Peoples Hospital of Zhengzhou University, Henan Provincial Peoples Hospital, Henan Provincial Interventional Therapy Center; Abstract： Objective To evaluate the safety and efficacy of stent implantation used as a rescue measure for acute ischemic stroke. Methods The cl inical data of 13 patients with acute ischemic stroke caused by large artery occlusion of anterior cerebral circulation that occurred within 8 hours before clinical visit, who had received rescue stent implemtdtion at authors， hosp it al, were ret respectively analyzed. Before stent i nip 1 anta tion, all patienls fai led to respond to other recanal ization treatments, including intravenous thrombolysis, intra-arterial thrombolysis, mechanical thrombectomy with Penumbra device, and Sol itairc stent thrombectomy. Angiography was performed immediately after stent implantation. Vascular recanalization condition was evaluated with blood flow grading that was based on thrombolysis in cerebral infarction (TICI) criterion. Perioperative bleeding and complications were recorded. National Institu