缺血性卒中急性期Solitaire AB支架机械取栓术的效果

Efficacy of mechanical thrombectomy with Solitaire AB stents during acute ischemic stroke

目的探讨自膨式、完全可收回Solitaire AB支架在缺血性卒中急性期血管再通治疗中的效果。方法回顾性分析2010年10月—2013年7月110例急性颅内大血管闭塞的缺血性卒中患者,发病8h内使用Solitaire AB支架进行机械取栓治疗的疗效。术后血管再通情况使用脑梗死溶栓分级(TICI)进行评估。术前和出院时使用美国国立卫生研究院卒中量表(NIHSS)评分。随访术后90 d改良Rankin评分量表(mRS)评分。结果①术后血管再通率为87.3%(96/110),其中TICI 3级为61.8%(68/110),TICI 2a级为10.2%(11/110),TICI 2b级为15.3%(17/110),12.7%(14/110)的患者血管未能再通。②出院时NIHSS评分(8±4)分,较入院时(18±4)分显著好转,差异有统计学意义(P=0.01)。③90d时,预后良好率(mRS≤2分)为43.6%,全组病死率为12.7%。结论 Solitaire AB支架能迅速、安全、有效地达到血管再通、血流恢复的治疗目标,提高颅内大血管闭塞引起的急性缺血性卒中的疗效。但尚需前瞻性随机对照研究进一步证实临床预后。

Objective To investigate the effectiveness and safety of a self-expanding solitaire AB retrievable stent in revascularization during acute ischemic stroke. Methods The efficacy of 110 patients with acute intracranial large vessel occlusion whom underwent mechanical thrombectomy using the Solitaire AB stent within 8 h after onset of stroke from October 2010 to July 2013 was analyzed retrospectively. Cerebral vascular recanalization after procedure was evaluated by using thrombolysis in cerebral infarction （TICI） grade. The National Institutes of Health Stroke Scale （NIHSS） score was used before procedure and at discharge. The modified Rankin Scale （mRS） score was performed after 90 days follow-up. Results The recanalization rate after procedure was 87.3%, in which TICI grade 3 was 61.8%, TICI grade 2a was 10.2%, and TICI grade 2b was 15.3%. 12.7% of the patients did not achieve recanalization. @The NIHSS score at discharge was 8.4 ＋ 3.9. It was improved significantly when compared to admission （ 17.8 ＋ 3.7）. There was significant difference （P = 0. 001 ）. ③At day 90, the rate of good prognosis （mRS ≤2） was 43.6%. The overall mortality rate was 12.7%. Conclusion Solitaire AB stent can quickly, safely and effectively achieve recanalization, restore blood flow therapeutic target, increase the efficacy of intracranial large vessel occlusion caused acute ischemic stroke, and improve the clinical prognosis. However, a prospective randomized controlled trial for further confirming the clinical prognosis is still needed.