Solitaire AB支架机械取栓治疗后循环急性缺血性卒中

Mechanical thrombectomy with the Solitaire AB device in acute ischemic stroke of posterior circulation ： a series of 17 cases

目的探讨应用SolitaireAB支架机械取栓治疗后循环急性缺血性卒中的效果及安全性。方法回顾性分析2011年8月至2015年8月在北京军区总医院神经外科急诊接受SolitaireAB支架机械取栓的17例后循环急性缺血性卒中患者的临床资料。男性12例，女性5例，年龄44～75岁，中位年龄60岁。基底动脉闭塞8例，椎动脉闭塞d例，椎动脉合并基底动脉闭塞5例。分析取栓治疗的再通率及并发症，采用t检验比较患者术前和术后1周美国国立卫生研究院卒中量表（NIHSS）评分，并采用改良Rankin评分（mRS）评价患者术后90d临床预后。结果17例患者中，血管成功实现再通15例，2例未能再通，发病时间均〉7．5h。17例患者均未出现症状性颅内出血。术后1周NIHSS评分为（11±10）分，较术前的（17±5）分明显降低（t=2．949，P=0．009）。术后90d随访，1例死亡（mRS6），1例严重残疾（mRS5），2例重度残疾（mRS4），4例中等残疾（mRS3），9例良好（mRS≤2）。2例死亡及严重残疾均为取栓失败的患者，2例重度残疾患者人院时NIHSS〉20分，发病时间〉6h。结论应用SolitaireAB支架取栓治疗后循环急性缺血性卒中相对安全，初步临床效果较好。

Objective To evaluate the efficacy and safety of mechanical thrombeetomy with the Solitaire AB device in reeanalization of patients with acute isehemie stroke of posterior circulation. Methods The clinical data of 17 consecutive patients with acute ischemic stroke of posterior circulation, treated with the Solitaire AB device from August 2011 to August 2015 in Department of Neurosurgery, the Military General Hospital of Beijing People＇s Liberation Army, were extracted and then retrospectively analyzed. There were 12 male and 5 female patients with a median age of 60 years （ ranging from 44 to 75 years ）. Among them, 8 cases occluded in basilar artery, 4 cases occluded in vertebral artery and 5 cases occluded in vertebral plus basilar artery. Recanalization rate as well as complications after treatment were analysized. Also, neurological functions of the patients before and after treatment, measured by National Institute of Health stroke scale （NIHSS） score, were compared via t test and the clinical outcomes were assessed by modified Rankin score （mRS） at 90 days after treatment. Results Fifteen patients resulted in successfully recanalization, and 2 cases failed both of whose onset to sheath time were above 7. 5 hours. The NIHSS score at 7 days was 11± 10, which was significantly decreased compared to the admission NIHSS score 17± 5 （ t = 2. 949, P = 0. 009）. No symptomatic intracranial hemorrhage case was found after thrombectomy. At 90 days, one patient died（ mRS 6）, one patient seriously disabled （ mRS 5 ）, two patients moderately seriously disabled （ mRS 4）, four patients resulted in moderate outcome （ mRS 3 ） and the other 9 patients achieved good outcome （mRS 0 to 2 ）. The dead and seriously disabled cases were both due to failure in recanalization. Two moderately seriously disabled cases were probably attributed to their severe admission condition （NIHSS 〉 20） and prolonged time （onset to sheath time 〉 6 hours）. Conclusion Mechanical thrombectomy with the Solitaire AB device contributes to a high rate of recanalization with a low probability ofcomplication and improves functional outcome in patients with acute ischemic stroke of posterior circulation.