伴有同侧颈内动脉狭窄或闭塞的进展性分水岭梗死的颈动脉支架置入术治疗

Carotid stenting for progressive cerebral watershed infarction patients with ipsilateral internal carotid stenosis or occlusion

目的：探讨颈动脉支架置入术在伴有同侧颈内动脉狭窄或闭塞的进展性分水岭脑梗死（progressive cerebral watershed infarction, PCWI）患者中的有效性和安全性。方法回顾性分析在进展期行颈动脉支架置入术的23例伴有同侧颈动脉狭窄或闭塞的 PCWI 患者的临床资料。其中18例为颈内动脉重度狭窄,5例为颈内动脉闭塞。颈内动脉重度狭窄患者行支架置入术。颈内动脉闭塞的患者行一期血管成形术,二期支架置入术。采用美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）评分和改良 Rankin 量表（modified Rankin Scale, mRS）评分评估术前和术后神经功能缺损。结果23例患者中22例成功实施支架置入术,心肌梗死溶栓（Thrombolysis In Myocardial Infarction, TIMI）血流分级均达到3级,技术成功率为95．7%（22/23）。术后无一例患者出现同侧大脑半球过度灌注。术后30 d 时平均 NHISS 评分较术前显著改善[（4．41±1．88）分对（10．00±1．47）分；t =11．234,P 〈0．001]。12例患者（52．2%）术前 TIMI 血流分级为3级。术后 TIMI 血流分级3级的患者比例较术前显著增高（95．7%对52．2%；χ2=11．274,P =0．002）。术前无一例 mRS 评分为0~2分,术后90 d时16例患者（69．6%）mRS 评分为0~2分。术后90 d时 mRS 评分0~2分的患者比例显著高于术前（69．6%对0%；χ2=24．533,P 〈0．001）。结论对于伴有颈内动脉狭窄或闭塞的 PCWI 患者,在进展期行支架置入术是安全的,能改善患者的转归。

Objective To investigate the effectiveness and safety of carotid stenting for progressive cerebral watershed infarction （PCWI） patients with ipsilateral internal carotid stenosis or occlusion during the progressive stage. Methods The clinical data of 23 PCWI patients with ipsilateral internal carotid stenosis or occlusion treated with carotid stenting during the progressive stage were analyzed retrospectively. Among them, 18 were severe internal carotid artery stenosis, and 5 were carotid artery occlusion. Carotid artery stenting were performed in patients with severe internal carotid artery stenosis. The first-stage angioplasty and second-stage stenting were performed in patients with internal carotid artery occlusion. The National Institutes of Health Stroke Scale （NIHSS） score and the modified Rankin scale （mRS） were used to evaluate preoperative and postoperative neurologic deficits. Results Twenty-two of 23 patients were stented successfuly, the Thrombolysis In Myocardial Infarction （TIMI） flow grade was 3, and the technical success rate was 95. 7% . None of the patients demonstrated hyperperfusion in the ipsilateral hemisphere. At day 30 postprocedure, the NHISS scores were significantly improved compared with before procedure （4. 41 ± 1. 88 vs. 10. 00 ± 1. 47; t = 11. 234, P 〈 0. 001）. The preprocedural TIMI flow grade was 3 in＆amp;nbsp;12 patients （52. 2% ）. Proportion of patients with TIMI flow grade 3 after procedure was significantly increased compared with before procedure （95. 7% vs. 52. 2% ; χ2 = 11. 274, P = 0. 002）. The proportion of patients with mRS scores 0-2 at day 90 after procedure was significantly increased compared with before procedure （69. 6% vs. 0% ; χ2 = 24. 533, P 〈 0. 001）. Conclusions Carotid stenting during the progressive stage is safe and it may improve the prognosis in PCWI patients with ipsilateral internal carotid stenosis or occlusion.