Solitaire AB可回收支架在急性缺血性卒中血管内治疗中的应用

Application of Solitaire AB stent in endovascular treatment of acute ischemic stroke

目的探讨Solitaire AB可回收支架治疗颅内前循环大动脉闭塞致急性缺血性卒中的有效性和安全性。方法回顾分析31例采用Solitaire AB支架机械取栓治疗颅内前循环大动脉闭塞致急性缺血性卒中患者的临床资料,采用脑梗死溶栓血流分级(TICI)评价血管再通、美国国立卫生研究院卒中量表(NIHSS)评价神经功能、改良Rankin量表(mRS)评价预后,记录围手术期栓塞事件以及术后3个月内颅内出血或死亡。结果 31例患者共使用33枚Solitaire AB支架,其中19例首次机械取栓即实现血管再通;11例进一步行支架植入术,9例实现血管再通,最终总体血管再通率为90.32%(28/31)。术后1周NIHSS评分(8.81±3.40)分,低于术前的(16.06±4.82)分(t=-7.104,P=0.000)。术后3个月预后良好(mRS评分≤2分)16例(51.61%)。围手术期发生栓塞事件3例,随访期间发生颅内出血4例,共死亡6例。结论 Solitaire AB支架用于急性缺血性卒中的机械取栓安全、有效,首次机械取栓血管再通失败可以联合支架植入术作为补充治疗。

Objective To evaluate the safety and efficiency of mechnieal thrombectomy with Solitaire AB stent in the treatment of acute ischemic stroke caused by large artery occlusion of anterior eirculation. Methods Clinical data of 31 patients with acute isehemic stroke caused by large artery oeclusion of anterior circulation, who underwent meehnieal thrombeetomy with Solitaire AB stent, were reviewed retrospectively. Recanalization results were assessed by immediate scale of thrombolysis in eerebral infarction （TICI） after thrombeetomy. National Institutes of Health Stroke Seale （NIHSS） was used to evaluate neurological function at one week after operation, and modified Rankin Scale （milS） was used to evaluate outcomes at 3 months after operation. Complications related to the procedure, such as periuperative embolie events, intraeranial hemorrhage or death within 3 months after operation, were recorded. Results A total of 33 Solitaire AB stents were used in 31 patients. The initial suec, ess rate of reeanalization was 61.29% （19/31）. Among the other 12 patients, one patient with TICI Grade 2a and favorable distal blood supply was not further freated, while 11 patients underwent stent implantation as a rescue treatment and 9 of them were successful. The final recanalization rate was 90.32% （28/31）. The NIHSS score one week after operation was 8.81 ± 3.40, which was significantly lower than the score 16.06 ± 4.82 on admission （t =- 7.104, P = 0.000）. Three months after operation, there were 16 patients （51.61%） with good prognosis （mils score ≤ 2）. Perioperative emholization occurred in 3 patients. Intraeranial hemorrhage occurred in 4 patients during the 3- month follow- up period, and 6 patients were dead. Conclusions The application of Solitaire AB stent in mechnieal thrombectomy for treating acute ischemie stroke is efficient and safe. Stent implantation can be used as adjunctive treatment when initial reeanalization with Solitaire AB stent is failed.