大脑中动脉M2段急性闭塞机械取栓临床疗效评估

Efficacy of Mechanical Thrombectomy for Acute Middle Cerebral Artery M2 Segment Occlusion

目的评估机械取栓应用于大脑中动脉(middle middle cerebral artery,MCA)M2段急性闭塞的有效性和安全性。方法回顾性收集MCAM2段急性闭塞并实施机械取栓患者的临床资料,以90dmRS评分分为良好结局(mRS评分0~2分)与不良结局(mRS评分>2分)组,比较两组基线临床资料、入院NIHSS评分、是否合并静脉溶栓、闭塞部位、颅内出血(symptomatic intracranial hemorrhage,SICH)、再通时间等资料的差异。结果共入组行机械取栓术的MCAM2段急性闭塞患者12例(男女各6例)。平均年龄(71.4±8.1)岁,入院NIHSS评分中位数为18分,术后即刻血管再通[改良的脑梗死溶栓(modified thrombolysis in cerebral infarction,mTICI)2b^3级]11例(91.6%),出血3例(25.0%),其中SICH1例(8.3%),24h时血管再通11例(91.6%)。90d良好结局组4例,不良结局组8例。良好结局组入院NIHSS评分低于不良结局组(中位数14分vs22分,P=0.038),两组间其余因素差异无统计学意义。结论MCAM2段急性闭塞机械取栓的有效性及安全性有待观察,患者入院时NIHSS评分较低与90d预后良好有关。

Objective To evaluate the efficacy and safety of mechanical thrombectomy for acute middle cerebral artery (MCA) M2 segment occlusion. Methods The data of patients undergoing mechanical thrombectomy for acute MCA M2 segment occlusion were retrospectively collected. The primary outcome was mRS score at 90 days, favorable outcome was defined as mRS 0-2 and unfavorable outcome was mRS>2. Baseline data, NIHSS on admission, intravenous thrombolysis or not, part of occlusion, and intracranial hemorrhage were compared between the two groups. Results A total of 12 patients (6 males and 6 females) were included. The mean age was 71.4±8.1 years old, and the median NIHSS was 18. The successful vascular recanalization [modified thrombolysis in cerebral infarction (mTICI) 2b or 3 at end of procedure] was achieved in 11 cases (91.6%), and recanalization rate at 24 hours was 91.6%. Cerebral hemorrhage occurred in 3 patients, with symptomatic intracranial hemorrhage in 1 case (8.3%). 4 cases had favorable outcome and 8 cases had unfavorable outcome at 90 days. The NIHSS score on admission in favorable outcome group was lower than that in unfavorable outcome group (14 vs 22, P=0.038), and the difference in other factors between the two groups had no statistical significance. Conclusions The efficacy and safety of mechanical thrombectomy for acute MCA M2 occlusion still remains to be uncertain. The lower NIHSS score on admission is associated with good prognosis at 90 days in patients undergoing mechanical thrombectomy for acute MCA M2 occlusion.