应用Trevo ProVue支架取栓治疗前循环脑动脉急性闭塞的初步经验

Preliminary Experience in Mechanical Thrombectomy Using Trevo ProVue Stent for Acute Occlusion in Anterior Cerebral Circulation

目的探讨应用Trevo ProVue支架对前循环脑动脉急性闭塞进行支架取栓治疗的安全性及有效性。方法回顾本中心13例采用Trevo ProVue支架取栓治疗前循环脑动脉急性闭塞患者的临床资料。应用改良脑梗死溶栓(modified thrombolysis in cerebral infarction,mTICI)分级评估闭塞血管再通情况,比较患者术前及术后24 h美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分。并于术后90 d进行临床随访,采用改良Rankin量表(modified Rankin scale,mRS)评分评估患者独立生活情况。结果 13例患者中,术后即刻8例获得mTICI分级2b～3级再通,4例mTICI分级2a级再通,1例血管无法开通mTICI分级0级。患者入院时NIHSS评分15.0(9.5～21.0)分,术后24 h NIHSS评分7.0(5.5～16.0)分,比较差异具有统计学意义(t=2.38,P=0.035)。90 d临床随访,mRS评分0～2分6例(46.15%),3分2例,4分2例,5分1例,6分(死亡)2例。结论应用Trevo ProVue支架取栓治疗前循环脑动脉急性闭塞是安全、有效的。

Objective To assess the safety and effectivity of mechanical thrombectomy using Trevo ProVue stents for acute arterial occlusion in proximal anterior cerebral circulation.Methods This retrospective study included 13 consective patients with acute arterial occlusion in anterior cerebral circulation and treated by thrombectomy using Trevo ProVue stents. Revascularization status of the occluded arteries were evaluated using modified thrombolysis in cerebral infarction（mTICI） scale. The National Institute of Health stroke scale（NIHSS） score of all patients before operation and 24 hours after operation were compared. The functional outcome at 90 days were assessed using modified Rankin scale（mRS） score.Results Of 13 patients, 8 cases reached successful reperfusion（mTICI 2 b/3）, 4 cases reached a recanalization of mTICI 2 a, and the occluded artery couldn＇t be opened only in 1 case. The NIHSS score of patients on admission was 15.0（9.5-21.0）, the NIHSS score was 7.0（5.5-16.0） 24 hours after operation, and there was significant difference between the two scores（t=2.38, P=0.035）. The clinical follow-up results at 90 days showed that six patients had a mR S score of 0-2, four patients had a mRS score of 3-4, one patient had a mRS score of 5, and two patients had a mRS score of 6.Conclusions Mechnical thrombectomy with Trevo ProVue stents for acute arterial occlusion in anterior cerebral circulation is safe and effective.