Solitaire AB支架取栓术治疗急性大脑中动脉闭塞八例

Thrombectomy with Solitaire AB stent in the treatment of acute middle cerebral artery occlusion:eight cases report

目的探讨采用SolitaireAB支架机械中取栓术治疗急性大脑中动脉(MCA)闭塞的疗效。方法回顾性分析2010年11月—2011年4月苏州大学附属常州市第一人民医院神经外科采用Solitaire AB支架,机械取栓术治疗的发病时间为4～7 h的急性MCA闭塞8例患者的临床资料。其中2例因术中造影显示M2段中的一分支动脉显影不佳,使用尿激酶20万U。结果①8例均获取栓成功,造影显示MCA再通;从微导管进入导引导管到血管重新开通时间为(25±5)min。其中使用尿激酶的1例患者术后有左侧颞、顶叶梗死,其余7例术后MRI或CT灌注虽显示病侧有小梗死灶,但患者功能恢复良好,无手术相关并发症和脑出血。术后1周,美国吲立卫生研究院卒中量表评分为4.7±1.2,与术前的14.9±0.9比较,差异有统计学意义(t=29.83,P<0.01)。②5例患者出院后1个月采用CT 血管成像(CTA)和 CT灌注随访,CTA显示取栓侧MCA均通畅,CT灌注显示2例的取栓侧血流量仍较正常侧差,3例的取栓侧血流量和正常侧相比,基本恢复正常。③出院后1～3个月随访改良Rankin评分,其中0分为4例,1分为2例,2分为2例。结论 Solitaire AB支架取栓技术缩短了闭塞血管的升通时间,提高了开通率,减少甚至不用溶栓药物;而且治疗急性MCA闭塞是安全、有效的。

Objective To investigate the effect of mechanical thrombeetomy with a Solitaire AB stent in the treatment of acute middle cerebral artery （MCA） occlusion. Methods The clinical data of 8 patients with acute MCA occlusion （onset time 〈 4 -7 hours） treated by mechanical thrombectomy with a Solitaire AB stent in the Department of Neurosurgery, Changzhou NO. 1 People＇s Hospital Affiliated to Soochow University from November 2010 to April 2011 were analyzed retrospectively. Two of them were treated with 200 000 U of urokinase because the intraoperative angiography showed that an M2 segment developed poorly. Results ①Thrombeetomy was successful in 8 patients and angiography showed that MCA recanalization was achieved. The time from the microcatheter into the guiding catheter to the vascular recanalization was 25±5 minutes. One of the patients who used urokinase had left temporal lobe infarction after procedure. The other 7 showed small infarcts on MRI or CT perfusion imaging after procedure, however, the functional recovery of the patients was good. No procedure-related complications or intracranial hemorrhages were noted. The National Institutes of Health Stroke Scale （NIHSS） score was 4.7 ±1.2 one week after procedure compared to 14.9 ± 0.9 before procedure. There was significant difference （ t = 29.83, P 〈0.01 ）. ②5 patients were followed up with CTA and CT perfusion imaging 1 month after discharge. CTA showed that all MCAs were patent on the side of thrombectomy. CT perfusion imaging showed that the blood flow volume on the side of thrombectomy in 2 cases was worse than that on the normal side. Compared to the blood flow volume on the normal side, the side of thrombectomy in 3 patients almost returned to normal. ③1-3 months after discharge, the follow-up modified Rankin Scale （mRS） showed 0 in 4 cases,1 in 2 cases, and 2 in 2 cases. Conclusion The thrombectomy techniques of Solitaire stent may shorter the time of recanalization of vascular occlusion, improve the recanalization rate, and reduce or even unnecessary use thrombolytie drags. The treatment of acute MCA occlusion is safe and effective.