血管内治疗前循环不同部位及原因血管闭塞导致的急性脑梗死5例分析

Endovascular treatment to 5 patients of acute cerebral infarction caused by vascular occlusion in different parts of anterior circulation

目的探讨前循环不同部位血管病变导致的急性脑梗死患者,经血管内治疗所采取的不同方法以及临床效果和安全性。方法回顾性分析2016年3月-2016年12月采用单纯Solitaire FR支架行急性脑梗死动脉取栓术、中间导管吸栓或结合血管内支架成形,治疗5例具有代表性的前循环不同部位血管闭塞导致的急性脑梗死患者,其中颈内动脉起始部闭塞1例、颈内动脉海绵窦段闭塞1例、颈内动脉起始部重度狭窄合并颈内动脉末端闭塞1例、大脑中动脉M1段闭塞1例、M2段主干闭塞1例。评价取栓或血管内成形治疗后即刻、24 h及术后3 m效果。结果 5例患者均获得闭塞血管再通,但操作方法各异,无明显与操作相关并发症,术后24 h平均NIHSS评分较术前减少7分。术后3 m,5例患者mRS评分0~2分。结论依据不同部位、不同原因的血管闭塞,个体化使用Solitaire FR支架取栓治疗、中间导管血栓抽吸或血管内支架植入术及球囊扩张术等血管成形术,治疗急性脑梗死,能提高闭塞血管的再通率,有效改善颅内外大血管闭塞患者的预后。

Objective To explore the different methods and clinical effects and safety of endovascular treatment in patients with acute cerebral infarction caused by vascular lesions in different parts of the anterior circulation. Methods Retrospective analysis from March 2016 to December 2016 alone using Solitaire FR stent arterial thrombectomy, medial catheter embolization or combined with endovascular stenting treatment for 5 patients with representative acute cerebral infarction in different parts of the anterior circulation caused by blood vessels occlusion,including 1 case of the beginning internal carotid artery occlusion, I case of carotid artery cavernous sinus occlusion, 1 case of carotid artery at the beginning of severe stenosis with end of internal carotid artery occlusion, M1 of middle cerebral artery occlusion in 1 case, M2 block trunk occlusion in 1 case. Evaluation the effect of thrombectomy or endovascular treatment immediately after,24 hours and after 3 months. Results 5 patients had occlusive vascular recanalization,but the operation methods were different, no obvi- ous complications related to operation. The average NIHSS score was average reduction 7 points. 3 months after surgery, 5 patients with mRS score of 0 - 2 points. Conclusion According to different parts, different causes of vascular occlusion, in- dividual use of Solitaire FR stent thrombectomy, intermediate catheter thrombosis or endovascular stent implantation and balloon dilatation and other angioplasty in the treatment of acute cerebral infarction, can improve occlusion Vascular recanalization rate, effectively improve the prognosis of patients with intracranial and extravascular occlusion.