摘要
目的探讨药物治疗时间窗外的症状性椎动脉颅内段(ICVA)闭塞患者行血管内治疗的安全性和有效性。方法回顾性分析2014年1月至2019年12月间北京大学第一医院神经外科连续收治的9例接受血管内治疗的非急性早期症状性ICVA闭塞患者的临床资料。男性7例,女性2例,年龄63.4岁(范围:52~72岁)。术前患者改良Rankin量表评分4.3分(范围:4~5分),美国国立卫生研究院卒中量表(NIHSS)评分12.3分(范围:8~18分)。其中2例患者行同期血管内治疗;7例患者行分期血管内治疗,即一期应用微导丝通过闭塞病变并球囊成形,使血流保持在脑血流灌注分级系统分级2b级及以上,随后通过抗血小板药物及自身纤溶系统溶解病变部位附壁血栓;二期于残余重度狭窄部位行支架植入术。采用NIHSS评分及改良Rankin量表评分评价患者神经功能改善情况,记录血管内治疗的并发症及血管再通情况。结果2例同期血管内治疗患者虽经积极治疗后闭塞血管均再通,但1例术中出现血栓移位,1例出现拉栓后血管再次闭塞;分期治疗的7例患者中6例血管再通,出院时NIHSS评分平均5.7分(范围:3~14分);术后3个月改良Rankin量表评分平均1.6分(范围:0~3分),末次随访时平均0.9分(范围:0~2分),优于术前状态。结论分期血管内治疗是非急性早期症状性ICVA闭塞患者的一种治疗选择。
Objective To examine the clinical efficacy of endovascular treatment on symptomatic occlusion of intracranial vertebral artery(ICVA)in early non-acute stage.Methods Nine consecutive patients who presented with aggressive ischemic events in the early non-acute stage of ICVA occlusion from January 2014 to December 2019 and received endovascular treatment at Department of Neurosurgery,Peking University First Hospital were retrospectively reviewed.There were 7 males and 2 females,aged 63.4 years old(range:52 to 72 years).The average preoperative modified Rankin scale(mRS)was 4.3(range:4 to 5),the National Institute of Health stroke scale(NIHSS)was 12.3(range:8 to 18).Among them,2 patients received a single stage endovascular treatment,and the other 7 patients received staged endovascular treatment.The strategy of staged treatment was as follows:firstly,the occlusion part was passed through by a micro-guidewire and dilated with balloons to maintain the blood flow above Thrombolysis In Cerebral Infarction grade 2b.Then,the intravascular large load thrombus was eliminated by the fibrinolytic system and strengthened antiplatelet drugs.After that,a second stage of angioplasty with stenting was performed on the severe residual stenosis part.The complications and the recanalization rate were collected,and the National NIHSS and mRS after endovascular treatment and in follow-up period were recorded.Results In the 2 cases received single stage endovascular treatment,although revascularization was achieved lastly,one patient suffered embolus translocation and the other suffered re-occlusion after mechanical thrombectomy during the operation,respectively.Technical success was achieved in 6 of the 7 patients received staged endovascular treatment.On discharge,the average NIHSS scores was 5.7(range:3 to 4)of the patients.Three months after operation,the average mRS was 1.6(range:0 to 3)and it was 0.9(range:0 to 2)at the latest follow-up,which were better than preoperative status.Conclusions Staged endovascular treatment might be
作者
段鸿洲
袁昌巍
李春伟
伊志强
张扬
沈胜利
王盈进
张家湧
李良
Duan Hongzhou;Yuan Changwei;Li Chunwei;Yi Zhiqiang;Zhang Yang;Shen Shengli;Wang Yingjin;Zhang Jiayong;Li Liang(Department of Neurosurgery,Peking University First Hospital,Beijing 100034,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2020年第12期909-917,共9页
Chinese Journal of Surgery
基金
国家自然科学基金(81541119)
北京大学第一医院交叉临床研究专项资助项目
北京大学第一医院青年临床研究专项基金(2019CR02)。
关键词
动脉闭塞性疾病
椎动脉
血管内治疗
闭塞
血管再通
Arterial occlusive diseases
Vertebral artery
Endovascular treatment
Occlusion
Recanalization
