血管内机械再通治疗急性基底动脉闭塞的疗效分析

Analysis of effect of endovascular mechanical recanalization for acute basilar artery occlusion

目的探讨机械再通治疗急性基底动脉闭塞患者的近期疗效。方法回顾性分析12例基底动脉急性闭塞并接受支架辅助血管内再通治疗的患者资料。对8例患者使用Apollo或Wingspan支架,4例使用Solitaire AB支架。血管内介入治疗后按照脑梗死溶栓等级系统(TICI)分级评定血管再通情况。评估3个月后的临床结局。结果①基底动脉远段闭塞3例,近段闭塞4例,椎动脉颅内段延伸至基底动脉近段闭塞3例,基底动脉全程闭塞2例。术前美国国立卫生研究院卒中量表(NIHSS)评分的中位数为20(15～24)分。②血管内机械再通治疗的技术成功率为100%,10例达到充分再通标准。2例患者术中发生血管痉挛,无临床症状。1例发生症状性颅内出血。③患者出院时NIHSS评分中位数为10(4～22)分,同最初NIHSS评分相比,7例患者NIHSS评分改善≥5分。④4例术后3个月的功能转归良好,死亡3例。结论血管内机械再通治疗急性基底动脉闭塞具有较高的再通率,可改善3个月时的临床结局。针对基底动脉闭塞不同病因需要个性化的血管内治疗方法。

Objective To investigate the feasibility, for treatment of acute basilar artery occlusion. Methods safety and efficacy of mechanical recanallzatlon The clinical data of 12 patients with acute basi-lar artery occlusion and treated with stent-assisted endovascular recanalization were analyzed retrospective-ly. Eight patients were treated with Appollo or Wingspan stents, and 4 with Solitaire AB stents. Recanali-zation was assessed after endovascular treatment according to the thrombolysis in cerebral ischemia （TICI） grade. The clinical outcome was evaluated after 3 months. Results ①Three patients had distal basilar artery occlusions, 4 had proximal occlusion, 3 had occlusion extending from intracranial vertebral artery to the proximal basilar artery, and 2 had occlusion throughout basilar artery. The median National Institutes of Health Stroke Scale （NIHSS） scores before procedure were 20 （range 15 to 24）. ②The technical success rate of endovascular mechanical recanalization was 100% , 83.3% （10/12） achieved the criteria for com-plete recanalization. Two patients had vasospasm during the procedure, and they did not have any clinical symptoms. One patient had symptomatic intracranial hemorrhage. ③The median NIHSS score at discharge was 10 （range 4 to 22）. The NIHSS scores improved ≥ 5 points in 7 cases compared with the initial NIH-SS ones. @33.3% （4/12） patients had good outcome at 3 months after procedure. The mortality was 25% （3/12）. Conclusion Using stent-assisted mechanical recanalization for treatment of basilar artery occlusion has higher recanalization rate. It can improve the clinical outcome. The different etiologies of basilar artery occlusion may need the individualized intravascular interventional therapy.