Solitaire AB支架取栓后桥接治疗特殊类型脑梗死的临床分析

Solitaire AB stent thrombectomy combined with bridging therapy for special cerebral infarction

目的探讨Solitaire AB支架取栓后桥接治疗进展性和主动脉弓上动脉内大血栓负荷性特殊类型脑梗死的安全性和有效性。方法第1例Solitaire AB支架取栓后桥接支架置入治疗大脑中动脉主干闭塞超取栓时间窗进展性脑梗死;第2例取栓后桥接动脉溶栓治疗颈内动脉起始部至大脑中动脉主干大血栓负荷性脑梗死。术后均给予阿司匹林和氯吡格雷负荷量抗血小板聚集,低分子肝素钙抗凝。术后平均动脉压控制在90-120 mm Hg,同时给予神经保护治疗。结果第1例患者术前NIHSS评分15分,mRS评分为4分,取栓前m TICI分级0级,取栓桥接后m TICI分级3级,术后1周NIHSS评分0分,mRS评分1分,术后90 d NIHSS评分0分,mRS评分1分。第2例患者术前NIHSS评分12分,mRS评分5分,取栓前m TICI分级0级,取栓桥接后m TICI分级2b级,术后1周NIHSS评分2分,mRS评分1分,术后90 d NIHSS评分1分,mRS评分1分。2例患者均未出现明显并发症。结论在严格围手术期管理下使用Solitaire AB支架取栓桥接治疗超取栓时间窗大动脉闭塞进展性脑梗死和大动脉大血栓负荷性特殊类型脑梗死是安全和有效的。

Objective To investigate the safety and efficacy of Solitaire AB stent endovascular mechanical thrombectomy combined with bridging therapy for progressive ischemic stroke and acute ischemic stroke with higher arterial thrombus burden above the aortic arch. Methods One case with progressive ischemic stroke caused by middle cerebral artery（ MCA） occlusion and over the thrombectomy time window was treated by Solitaire AB stent thrombectomy and bridging intracranial stenting. The other case with higher arterial thrombus burden from the initial part of internal carotid artery（ ICA） to the trunk of MCA was treated by Solitaire AB stent thrombectomy and bridging rt-PA arterial thrombolysis. After operation,the patients in the neurosurgical care unit were administrated with the loading dose of aspirin and clopidogrel for inhibiting platelet aggregation,and low-molecular-weight heparin was applied for anticoagulation. The neutroprotective therapy was given,and the mean arterial pressure（ MAP） was controlled between 90 mm Hg and 120 mm Hg.Results The first case had national institutes of health stroke scale（ NIHSS） 15,modified Rankin scale（ mRS） 4,and modified thrombolysis in cerebral infarction（ m TICI） 0 before operation,while m TICI 3 after bridging therapy,NIHSS 0 and mRS 1 in 1 week,and NIHSS 0 and mRS 1 at 90 d after operation. The second case had NIHSS 12,mRS 5 and m TICI 0 before endovascular treatment,and m TICI 2b after bridging therapy,NIHSS 2 and mRS 1 in 1 week,and NIHSS 1 and mRS 1 at 90 d after operation. Two cases had no obvious complications after interventional treatment. Conclusion Solitaire AB stent thrombectomy combined with bridging therapy is safe and effective in treating progressive stroke over the thrombectomy time window and acute ischemic stroke with higher thrombus burden on large artery under strict perioperative management.