急性缺血性脑卒中Solitaire AB支架行血栓取出术的初步经验(附16例分析)

Mechanical thyroidectomy with the Solitaire AB device in 16 cases of acute ischemic stroke

目的探讨自膨胀、可完全收回的支架(Solitaire AB;ev3 Inc,California)在急性缺血性脑卒中血管再通治疗中的有效性及安全性。方法回顾性分析16例以颈内动脉和(或)大脑中动脉阻塞出现临床症状的缺血性脑卒中患者的临床资料,探讨在发病8 h内单独使用Solitaire AB支架行脑动脉血栓取出术的治疗方法与疗效,包括美国国立卫生院卒中量表NIHSS评分、治疗时间。结果所有患者在股动脉穿刺后90 min内完成血栓取出术,平均时间60 min,无一例患者在支架释放、去除血栓后需要其他辅助治疗,无与操作相关并发症出现。60%的患者在3个月后功能完全恢复。结论 Solitaire AB支架能迅速、安全、有效地达到血管再通、移除血栓,而不必终生支架置入的目的,可以作为一种有效的治疗方法,能降低病死率,减少并发症,改善患者预后。

Objective To investigate the safety and effectiveness of a self-expanding and fully retrievable stent （ Solitaire AB ; ev3 Inc, California） in revascularization of patients with acute ischemic stroke. Methods Sixteen patients who presented with acute ischemic stroke attributed to large artery occlusion of the anterior circulation within the first 8 hours from symptoms onset were retrospectively analyzed. The National Institutes of Health Stroke Scale score （ NIHSS）, the occlusion site of patients, the procedure time, treatment results and follow-up data were collected and analyzed. Results In all the cases, completed recanali- zation was achieved within 90 minutes after femoral access, the median time from groin puncture to recanalization was 60 mi- nutes. A single Solitaire AB was sufficient to achieve clot removal, no case required adjuvant therapy after the management, no significant procedural event occurred. No symptomatic intracranial hemorrhage was found, no stent was permanently implanted. Sixty percent of the patients showed good functional outcome at the 90-day follow-up period. Conclusion Patients with an acute ischemic stroke should be treated aggressively; the Solitaire AB device can rapidly, safely, and effectively retrieve clots, rapid endovascular revascularization, and no need of leaving a permanent implant. The Solitaire AB device is a safe, mini - invasive and effective therapy with few complication, and also can receive satisfying prognosis.