摘要
目的探讨血管内再通治疗症状性颅内动脉非急性期闭塞病例的安全性和可行性。方法回顾性收集2017年1月至2019年10月于北京医院神经外科行血管内再通治疗的25例症状性颅内动脉狭窄的连续病例资料。男性20例,女性5例,年龄(60.5±11.0)岁(范围:41~73岁)。术前改良Rankin量表评分为2(2.5)分[M(QR)](范围:1~5分)。颅内动脉闭塞时间为40(54)d(范围:17~570 d)。分析患者血管内治疗情况、临床和影像学随访结果及并发症情况。结果25例患者共接受27例次血管内再通治疗,其中20例次获得成功,技术成功率为74.1%;3例次(11.1%)出现手术相关并发症,其中1例次为导丝穿破动脉导致出血,1例次为动脉夹层出血,1例次为穿支闭塞;永久性并发症发生率为3.7%(1/27)。25例患者全部进行了临床随访,中位随访时间8个月(范围:1~33个月),改良Rankin量表评分改善或稳定者23例(92%)。1例(4%)出院后2个月出现新发缺血症状,1例(4%)因卧床相关并发症死亡。20例再通成功的患者获得影像学检查随访,中位随访时间为4个月(范围:2 d^9个月),5例(25%)患者出现再闭塞。结论症状性颅内动脉闭塞的非急性期血管内再通是一种技术可行、相对安全的治疗方式,但术前需进行充分的临床和影像学评估,严格筛选病例。
Objective To investigate the feasibility and safety of endovascular recanalization for symptomatic non-acute intracranial arterial occlusion(NAICO).Methods Twenty-five consecutive patients who underwent endovascular recanalization for NAICO between January 2017 and October 2019 at Department of Neurosurgery,Beijing Hospital were retrospectively reviewed.There were 20 males and 5 females,aged(60.5±11.0)years(range:41 to 73 years).The preoperative modified Rankin score(M(QR))was 2(2.5)(range:1 to 5).The occlusion time was 40(54)days(range:17 to 570 days).The demographic data were collected.The initial procedural results,including the rate of successful recanalization,periprocedural complications and data pertaining to angiographic and clinical follow-up were recorded.Results Recanalization was successful in 20 of 27 occlusive lesions of 25 patients.Intraoperative complications occurred in 3 cases,including vascular perforation in 1 case,arterial dissection in 1 case,and perforator occlusion occurred in 1 case.The incidence of permanent complications was 3.7%(1/27).All 25 patients underwent clinical follow-up,with a median period of 8 months(range:1 to 33 months),and 23 patients with improved or stable modified Rankin scale.One patient developed new ischemic symptoms 2 months after discharge,and 1 patient died of complications of bed rest.The results of the angiography follow-up(median 4 months,range:2 days to 9 months)showed that reocclusion occurred in 5 of all 20 successfully recanalized patients.Conclusions Endovascular recanalization for symptomatic NAICO is feasible,relatively safe,and efficacious in highly selected cases.However,further larger scale pilot studies are needed to determine the efficacy and long-term outcome associated with this treatment.
作者
王俊杰
祁鹏
陈鲲鹏
陆军
胡深
杨希孟
王大明
Wang Junjie;Qi Peng;Chen Kunpeng;Lu Jun;Hu Shen;Yang Ximeng;Wang Daming(Department of Neurosurgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2020年第12期897-903,共7页
Chinese Journal of Surgery
关键词
颅内动脉疾病
动脉闭塞性疾病
亚急性
慢性
血管内再通
Intracranial arterial diseases
Arterial occlusive diseases
Subacute
Chronic
Endovascular recanalization
