单中心急性缺血性卒中行机械取栓的疗效分析（附58例报告）

Clinical analysis of mechanical thrombectomy for acute ischemic stroke： a single-center study of 58 cases

目的分析对急性缺血性卒中患者行急诊机械取栓的疗效。方法回顾性纳入同济大学附属第十人民医院神经外科2016年1月至12月收治的58例急性缺血性卒中患者，对所有患者建立稳定的血管通路，采用取栓支架结合手动抽吸的方式行急诊机械取栓治疗。术中采用脑梗死溶栓（TICI）分级评估血管再通情况，术后24 h行头颅CT复查，支架置入患者术后3 d内行CT血管成像（CTA）检查评估支架内有无再狭窄或闭塞。出院前采用美国国立卫生研究院卒中量表（NIHSS）对患者进行评分。术后90 d对存活患者根据改良Rankin量表评分（mRS）行门诊或电话随访。结果58例患者自入院至穿刺开始平均时间为（98.2±21.6）min，穿刺至血管开通平均时间为（45.4±21.3）min。共86.2%（50/58）的患者术中实现成功再通（TICI 2b、3级），13.8%（8/58）未能有效再通。术后24 h头颅CT复查显示，并发大面积半球脑梗死4例，颅内出血7例，其中症状性颅内出血2例。12例患者（12枚支架）术中支架释放，术后3 d内行CTA检查显示，有2例支架内发生闭塞，其余通畅无再狭窄。出院前5例患者死亡，其余53例NIHSS评分平均为（5.9±4.7）分，较术前显著降低[（13.7±5.3）分，P〈0.05]。存活的53例患者术后90 d均获随访，mRS平均为（2.8±2.0）分，其中0～2分40例，预后良好率为68.9%（40/58）。结论通过建立稳定的血管通路，采用取栓支架结合手动抽吸的方式行急诊机械取栓是治疗急性缺血性卒中的有效手段。

ObjectiveTo analyze the clinical effect of emergent mechanical thrombectomy on acute ischemic stroke （AIS）.MethodsWe retrospectively studied a total of 58 cases of AIS admitted to Department of Neurosurgery, the Tenth People＇s Hospital Affiliated to Tongji University from January to December of 2016. In all patients, the protocol of establishing stable vascular access was performed and stent retriever combined with manual aspiration was applied. The thrombolysis in cerebral infarction （TICI） score used to assess intraoperative revascularization and head CT scan was performed at 24 h after operation. In patients with stents implanted, CT angiography （CTA） was conducted at 3 days post operation to assess restenosis or occlusion of the stents. The National Institutes of Health Stroke Scale （NIHSS） before discharge and modified Rankin Scale （mRS） score at 90 days post operation were documented.ResultsAmong all 58 cases, successful intraoperative revascularization （TICI score of 2b-3） was achieved in 86.2% （50/58） of the patients. The mean admission-to-puncture time and puncture-to recanalization time were 98.2±21.6 and 45.4±21.3 min. The 24-h postoperative CT scan revealed large-area infarction in 4 patients and intracranial hemorrhage in 7 patients including 2 symptomatic cases. Five cases died before discharge. Long-term follow-up in the remaining 53 cases reported significant statistic difference （P〈0.05） between the NIHSS score before discharge （5.9±4.7） and preoperative NIHHS score （13.7±5.3）. The 90-d postoperative follow-up results indicated good outcome （mRS score of 0-2） in 68.9% （40/58） of the patients and the mean mRS score was 2.8±2.0.ConclusionWith the establishment of stable vascular access and application of stent retriever combined with manual aspiration, emergent mechanical thrombectomy remains an effective treatment method of AIS.