摘要
目的 评价前循环急性多发闭塞（AMO）病变血管内治疗的安全性及有效性.方法 回顾性分析血管内治疗10例AMO病变患者的临床资料.先对颈内动脉近端病变行球囊扩张并将导引导管置于理想位置,以动脉溶栓和（或）取栓开通颅内血管后对颅外近端病变血管行支架植入.依脑梗死溶栓等级系统（TICI）分级评定颅内血管再通情况.临床随访3个月后对患者进行改良Rankin量表评分（mRS）,评估预后情况.入院及出院时美国国立卫生研究院卒中量表（NIHSS）评分比较采用配对样本t检验进行比较.结果 所有患者近端颈内动脉病变均成功行球囊扩张,并置入指引导管至理想位置.9例颅内病变血管成功再通（TICI≥2b）,并对8例近端颈内动脉成功行支架植入,1例颈内动脉栓塞,栓子较大无法取出,未植入支架,但椎动脉造影示后交通动脉代偿可,结束手术.1例颅内病变未能再通,未再对近端颅外病变血管进一步处理.术后3例出现围手术期并发症,其中无症状少量蛛网膜下腔出血1例,症状性颅内出血2例（1例死亡）.3个月后临床随访结局良好者5例、中等2例、差2例.患者入院时NIHSS评分平均（15.7±2.2）分,出院平均（9.6±4.7）分,2者差异有统计学意义（t=2.86,P=0.02）.结论 血管内重建治疗AMO病变技术可行,相对安全、有效.
Objective To evaluate the safety and efficacy of the endovascular treatment of anterior circulation multiple occlusions （AMO） in acute ischemic stroke.Methods The clinical data of 10 patients with AMO treated by endovascular method from January 2011 to August 2013 were retrospectively analyzed.The proximal internal carotid artery （ICA） occlusion was treated using angioplasty in order to achieve ideal location of the guiding catheter.When necessary,stenting was performed after the reconstitution of the intracranial vessel.Recanalization was assessed according to the thrombolysis in cerebral ischemia （TICI） grade.Clinical prognosis was assessed using mRS at 3 months.The National Institutes of Health Stroke Scale （NIHSS） on admission and at discharge was compared using t test.Results The intracranial vessel was recanalized successfully （TICI ≥ 2b） in 9 cases and cervical carotid was stented in 8 cases.Adverse events were recorded in 3 patients,including one case of asymptomatic subarachnoid hemorrhage and two cases of symptomatic intra-cerebral hemorrhage.Mortality rate was 10 ％ （n=1）.At the three-month follow up,mRS ≤ 2 was observed in five patients.The mean NIHSS scores was 15.7±2.2 on admission and 9.6±4.7at discharge,and the difference was statistic significant（t=2.86,P=0.02）.Conclusion Endovascular therapy of AMO is technically feasible,and relatively safe and effective.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2014年第9期754-757,共4页
Chinese Journal of Radiology
关键词
动脉闭塞性疾病
颈内动脉
大脑中动脉
放射学
介入性
Arterial occlusive diseases
Carotid artery, internal
Middle cerebral artery
Radiology, interventional
