Solitaire支架取栓对前循环不同部位大血管闭塞的疗效分析

Effect analysis of Solitaire stent retriever thrombectomy in anterior circulation occlusion involving various locations

目的评估Solitaire支架取栓对前循环不同部位大血管急性闭塞的疗效。方法回顾性纳入2015年3月至2017年9月于解放军第一О一医院神经外科行Solitaire支架取栓的148例急性大血管闭塞性卒中患者，依据其闭塞部位分为颈内动脉（ICA）组（42例）、大脑中动脉（MCA）M1组（70例）以及MCAM2组（36例）。应用改良脑梗死溶栓（mTICI）分级评估术后的血管再通程度。采用美国国立卫生研究院卒中量表评分（NIHSS）、改良Rankin量表评分（mRS）评估患者的预后。比较三组的基线资料、影像学特征、发病至再通时间、手术时间、再通情况、围手术期并发症以及术后90dmRS，并分析Solitaire支架取栓对三组疗效的差异。结果148例患者中，96例（64．9％）获得完全再通，ICA组、MCAM1组以及MCAM2组完全再通的比率分别为66．7％（28／42）、71．4％（50／70）、50．0％（18／36），差异无统计学意义（P=0．091）。术后90d，76例（51．4％）预后良好（mRS0～2分），ICA组、MCAM1组以及MCAM2组的预后良好率分别为42．9％（18／42）、58．6％（41／70）以及47．2％（17／36），但差异无统计学意义（P=O．231）。ICA组和MCAM1组中，术后完全再通者的预后良好率分别为57．1％（16／28）和70．0％（35／50），显著高于未完全再通者的14．3％（2／14）和30．0％（6／20）（P值分别为0．009和0．003）。在MCAM2组中，完全再通和未完全再通者的预后良好率分别为55．6％（10／18）和38．9％（7／18），两者的差异无统计学意义（P=0．514）。结论前循环不同部位大血管急性闭塞患者接受Solitaire支架取栓治疗后的再通结果和临床预后相似。与MCAM2段闭塞患者相比，ICA和MCAM1段闭塞患者更能从支架取栓治疗后的成功再通中获益。

Objective To evaluate the technical success and clinical functional outcomes of mechanical thrombectomy （MT） by Solitaire stentt in anterior circulation occlusion involving varying locations. Methods We retrospectively reviewed 148 patients with anterior circulation occlusion who were admitted to Department of Neurosurgery, 101st Hospital of PLA and underwent MT from March 2015 to September 2017. According to locations, all patients were divided into internal carotid artery （ICA） group （ n = 42）, middle cerebral artery （MCA） M1 group （ n = 70） and M2 group （ n = 36 ）. Revascularization was evaluated with modified thrombolysis in cerebral infarction （mTICI）. Clinical outcomes were assessed based on National Institutes of Health stroke scale （NIHSS） and modified Rankin scale （mRS）. Baseline clinical and imaging variables, time from onset to recanalization, duration of the procedure, revascularization, perioperative complications and mRS at 90 d post stroke were documented. Results The results of mTICI 2b or 3 was achieved in 96 （ 64.9% ） cases and there were no significant differences among the 3 groups [ 66.7% （ 28/ 42） ,71.4% （50/70） ,50.0% （18/36） ,P = 0.091 ]. Overall, 76 out of 148 （51.4%） patients experienced favorable clinical outcome （mRS of 0 -2） with no significant difference among the 3 groups [42.9% （18/ 42） ,58.6% （41/70）,47.2% （17/36）,P =0.231 ]. In ICA and M1 groups, favorable clinical outcome was more often seen in patients who achieved successful recanalization （ICA： 57.1% vs. 14.3%, P = 0. 009; M1 ： 70.0% vs. 30.0%, P = 0.003 ）. In patients with M2 occlusions, favorable clinical outcome was reported in 55.6% （10/18） of cases with successful recanalization and 38.9% （7/18） of those with unsuccessful recanalization, which had no significant difference （P = 0. 514）. Conclusions There seems to be no statistically significant difference in the recanalization or clinical outcomes among ICA, M1 and M2 cases that underwent treatment with Solitaire stent. The beneficial effect of endovascular reperfusion using Solitaire steut might more pronounced for patients with ICA and M1 occlusions than for patients with M2 occlusions.