Solitaire AB支架取栓治疗静脉溶栓禁忌的急性缺血性脑卒中

Mechanical thrombectomy using Solitaire AB stent in acute ischemic cerebral stroke with intravenous thrombolysis taboo: a report of 19 cases

目的探讨应用Solitaire AB支架机械取栓治疗静脉溶栓禁忌的急性缺血性脑卒中的疗效和安全性。方法回顾性分析2015年1月~2016年8月在吉林大学第二医院接受Solitaire AB支架机械取栓治疗的19例静脉溶栓禁忌的急性缺血性脑卒中患者的临床资料。男性13例,女性6例,年龄30~82岁,静脉溶栓禁忌的因素为超过最佳溶栓时间窗(6 h)和(或)NIHSS评分较高(>22)。采用t检验比较患者术前和术后脑梗死溶栓分级(TICI分级)、术前和术后1 w的NIHSS评分的变化评价疗效,采用术后90 d改良的Rankin量表(mRS)评估预后。结果 19例患者中的18例责任血管均成功获得再通,再通率94.7%。从发病到血管再通时间:颈内动脉系统为(6.8±1.5)h,椎动脉系统为(10.0±2.9)h,其中从穿刺到再通时间为(83.3±39.9)min。术前NIHSS评分为(27.3±9.0)分,术后7 d时NIHSS评分为(9.71±7.98)分,较术前有明显改善(P<0.01)。术后90 d随访,预后良好者11例(mRS 0~2),预后良好率为57.89%,死亡3例,死亡率为15.79%。结论 Solitaire AB支架取栓治疗静脉溶栓禁忌的急性缺血性脑卒中安全有效,血管再通率高,可明显改善临床预后。

Objective To evaluate the efficacy and safety of mechanical thrombectomy using Solitaire AB stent in acute ischemic cerebral stroke with intravenous thrombolysis taboo. Methods The clinical data of 19 patients with acute ischemic stroke and intravenous thrombolysis taboo,treated with the Solitaire AB stent from January 2015 to August 2016 in Department of Neurosurgery,the second hospital of Jilin University,were extracted and retrospectively analyzed. There were13 male and 6 female patients,aged from 30- 82. The related factors of intravenous thrombolysis taboo are were beyond the therapeutic time-window for intravenous thrombolysis（ 6 hours） and/or a higher score of National Institute of Health Stroke Scale（ NIHSS 22）. The scale of thrombolysis in cerebral infarction（ TICI） before and immdiate after thrombectomy,the score of NIHSS before and 7 days after treatment were compared via t test and the clinical outcomes were assessed by modified Rankin Score（ mRS） at 90 days after treatment. Results Of 19 patients,successful and complete recanalization was obtained in 18（ 94. 7%）,and one case failed. The time from symptom onset to revascularization was（ 6. 8 ± 1. 5） h in the internal carotid artery system and（ 10. 0 ± 2. 9） h in the vertebral artery system. The time from puncture to reperfusion was（ 83. 3 ± 39. 9） min. The NIHSS score 27. 3 ± 9. 0,which was significantly decreased compared to the admission NIHSS score 9. 71 ± 7. 98（ P〈0. 01. At 90 days,11 patients（ 57. 89%） had an mRS score of 2,3 patients died（ 15. 79%）. Conclusion Mechanical thrombectomy using Solitaire AB stent for acute ischemic cerebral stroke with intravenous thrombolysis taboo,contributes to a high rate of recanalization,dramatically improves clinical outcome and is safe and effective.