Solitaire AB型支架取栓术治疗急性大脑中动脉闭塞

Embolectomy with solitaire AB stent in the treatment of acute middle cerebral artery occlusion

目的：观察 Solitaire AB 型支架取栓术治疗血栓栓塞造成的急性大脑中动脉闭塞或合并颈内动脉闭塞的效果。方法因急性血栓栓塞造成的单纯大脑中动脉闭塞患者5例、大脑中动脉闭塞合并同侧颈内动脉不同节段闭塞患者8例。13例患者在发病6 h 内接受了取栓治疗，利用 Solitaire AB 型支架取栓。结果13例患者中，10例闭塞血管再通、3例闭塞血管部分再通；出院时美国国立卫生研究院卒中量表（NIHSS）评分（中位数）为6（4）分，较术前 NIHSS 评分（中位数）19（4．5）分明显下降（P ＜0．01）。10例闭塞血管再通患者中，4例恢复良好（mRS 评分0～2分）、4例残疾（mRS 评分≥3分）、1例死于原发性肾病、1例死于心力衰竭；3例闭塞血管部分再通患者中，1例术后第90天随访 mRS 评分4分，2例因大面积脑梗死死亡。13例患者中，8例术后24 h 颅脑 CT 扫描示脑梗死灶内出血。结果 Solitaire AB 型支架取栓术治疗血栓栓塞造成的急性大脑中动脉闭塞或合并颈内动脉闭塞可获得较高的血管再通率，临床效果较好。

Objective To observe the efficacy of using embolectomy with a solitaire AB stent in the treatment of acute middle cerebral artery occlusion or accompanying internal carotid artery occlusion caused by thromboembolism.Methods Five cases of patients with middle cerebral artery occlusion caused by acute thromboembolism,and 8 patients with middle cerebral artery occlusion combined with ipsilateral internal carotid artery occlusion were selected.All patients within 6 hours of the onset underwent embolectomy with a solitaire AB stent.Results Of the 13 patients,10 needed recanalized successfully and 3 needed partial recanalization.The national institute of health stroke scale （NIHSS）median was 6（4） score at discharge which dropped significantly as compared with before procedure 19（4.5）.During 10 patients with reca-nalization,4 of them had good prognosis （mRS0-2）and 4 had disability （mRS≥3）,1 case died of primary nephrotic syn-drome and 1 case died of heart failure.During 3 patients with partial recanalization,1 case had disability （mRS4）within 90 days and 2 patients died of massive cerebral infarction.In 13 patients,8 patients had post-infarction intracranial hemor-rhage.Conclusion For the treatment of acute thromboembolism-caused middle cerebral artery occlusion or combined with internal carotid artery occlusion,the effect of embolectomy with a solitaire AB stent can get higher vascular recanalization rate and get satisfactory clinical outcome.