支架植入作为补救性治疗措施在可回收支架取栓治疗失败中的应用分析

Intracranial stenting as a rescue therapy for acute anterior large vessel occlusive stroke after retrievable stent thrombectomy failure

目的探讨支架植入作为补救性治疗措施用于急性前循环大血管闭塞性卒中可回收支架取栓治疗失败患者的安全性和有效性。方法回顾性收集河南省人民医院(郑州大学人民医院)脑血管病分院自2014年1月至2017年12月行可回收支架取栓治疗失败的60例急性前循环大血管闭塞性卒中患者的临床资料,其中43例以支架植入作为最终补救性治疗措施(支架植入补救组),17例以单纯球囊扩张、动脉溶栓等为补救性治疗措施(非支架植入补救组),均于术后即刻应用改良脑梗死溶栓(mTICI)分级评估血管再通情况,均于术后90d应用改良Rankin量表(mRS)评分判断预后,并记录围手术期症状性颅内出血和术后6个月内支架内再狭窄的发生情况。结果与非支架植入补救组比较,支架植入补救组患者术后即刻血管再通率(35.29%vs.81.40%)、预后良好率(23.53%vs.53.49%)明显较高,差异均有统计学意义(P<0.05);而症状性颅内出血率(11.76%vs.13.95%)、死亡率(29.41%vs.23.26%)在2组间差异均无统计学意义(P>0.05)。DSA随访示支架植入补救组患者中4例发生支架内再狭窄,但均为非症状性的。结论支架植入作为急性前循环大血管闭塞性卒中可回收支架取栓治疗失败的补救性治疗措施相对安全有效。

Objective To evaluate the efficacy and safety of intracranial stenting as a rescue therapy for acute anterior large vessel occlusive stroke after stentriever thrombectomy failure. Methods A total of 60 patients with acute anterior large vessel occlusive stroke failed to stent retriever thrombectomy in our hospital from January 2014 to December 2017 were chosen in our study. Among the 60 patients with stent retrieval failure, 43 patients received stent placement as rescue therapy (stenting rescue group), and 17 patients received other methods as rescue therapy (non-stenting rescue group). Modified thrombolysis in cerebral infarction grading was applied to evaluate vascular re-canalization immediately after operation;modified Rankin scale (mRS) was applied to determine the prognoses of the patients 90 d after operation;the occurrences of symptomatic intracranial hemorrhage and stent re-stenosis within 6 months after operation were recorded in the two groups. Results As compared with those in the non-stenting rescue group, the rate of immediate postoperative vascular re-canalization and favorable prognosis rate in the stenting rescue group (35.29% vs. 81.40% and 23.53% vs. 53.49%) were statistically higher (P<0.05). There were no statistically significant differences in proportions of symptomatic intracranial hemorrhage and death between the stenting rescue group and non-stenting rescue group (11.76% vs. 13.95%;29.41% vs. 23.26%, P>0.05). DSA follow-up showed that 4 patients in the stenting rescue group had stent re-stenosis, but all of them were asymptomatic. Conclusions Intracranial stenting as a rescue therapy for acute anterior large vessel occlusive stroke after failure of retrieval stent is feasible and safe.