反常脑栓塞的临床诊断及血管内治疗

Clinical Diagnosis and Endovascular Treatment of Abnormal Cerebral Embolism

目的评价反常脑栓塞的血管内治疗疗效、临床诊断方法及卒中二级预防。方法回顾分析2008年1月～2017年5月在扬州大学附属医院经血管内治疗的重症隐源性卒中患者11例的影像及临床资料。术后1周内对所有CS患者行经食管超声心动图检查,反常性栓塞风险量表评分,术后3个月采用改良Rankin评分(m Rs)评估患者的临床预后。结果接受血管内治疗的重症CS患者共11例,经食管超声心动图检查明确卵圆孔未闭者6例,其中合并房间隔瘤2例。6例反常栓塞患者经血管内治疗后血管再通率(TICI 2b/3级)100.00%,RoPE评分均>6分,平均(7.81±1.20)分,预后良好(m RS≤2分)者4例(66.67%),3例患者于术后6个月内行卵圆孔介入封堵治疗。结论 PFO致反常脑栓塞血管内治疗再通率高,临床预后相对好,结合经食管超声心动图检查利于明确病因及脑卒中的二级预防。

Objective To evaluate the efficacy, clinical diagnosis and secondary prevention of stroke in patients with abnormalcerebral embolism.Methods The imaging and clinical data of 11 patients with severe cryptogenic stroke who underwent endovasculartreatment at the Affiliated Hospital of Yangzhou University from January 2008 to May 2017 were retrospectively analyzed.All patientswith CS underwent transesophageal echocardiography within 1 week after surgery,and the abnormal embolism risk scale was scored.The clinical outcome was assessed by modified Rankin scores （mRs）3 months after surgery.Results A total of 11 patients with severeCS who underwent endovascular treatment were treated with esophageal echocardiography and6 patients with patent foramen ovale,including 2 patients with atrial septal tumor.6 patients with abnormal embolization had an vascular recanalization rate （TICI 2b/3）of100.00%,a RoPE score of 〉6,an average of （7.81±1.20）,4 patients （66.67%）hada good prognosis （mRS≤2 points）,and3 patientsunderwent interventional closure of the foramen ovale within6 months after surgery.Conclusion PFO-induced abnormal cerebralembolization hasa high recanalization rate and a relatively good clinical prognosis.Combined with transesophageal echocardiography,it is helpful to identify the secondary causes of etiology and stroke.