县级综合卒中中心应用Solitaire支架机械取栓联合Navien导管抽吸技术治疗急性前循环大血管闭塞的效果分析

Effect analysis of Solitaire stent combined with Navien aspiration for large vessel occlusion of anterior circulation perform ed in county com prehensive stroke centers

目的探讨县级综合卒中中心使用Solitaire支架机械取栓联合Navien导管抽吸技术治疗前循环大血管闭塞的安全性及有效性。方法回顾性连续纳入2018年3—12月太仓市第一人民医院卒中中心收治的前循环大血管闭塞患者17例,均接受了Solitaire支架机械取栓联合Navien导管抽吸技术治疗,其中男10例,女7例;美国国立卫生研究院卒中量表(NIHSS)评分8~22分,平均(14±4)分;大脑中动脉M1段闭塞12例,大脑中动脉分叉部闭塞1例,颈内动脉起始段闭塞4例;醒后卒中4例,院内卒中1例。记录患者年龄、性别、发病至入院时间(ODT)、入院至溶栓时间(DNT)、入院至穿刺时间(DPT)、穿刺至再通时间(PRT),对比术前及术后24 h NIHSS评分的改变,评价血管再通情况[脑梗死溶栓(TICI)分级2b^3级为成功再通]、并发症发生比例和术后90 d预后良好[改良Rankin量表(mRS)评分≤2分]比例。结果17例患者中,静脉溶栓后桥接动脉取栓治疗5例,单纯动脉取栓12例;ODT为1.0~5.5 h,中位时间3.0(2.0,4.7)h;DNT为26~35 min,平均(30±4)min;DPT为79~276 min,平均(152±53)min;PRT为27~134 min,平均(57±33)min;支架取栓次数为1~3次,中位次数1(1,2)次。取栓后即刻行DSA检查,17例患者中,TICI 2a级2例,TICI 2b级5例,TICI 3级10例,血管再通占比为15/17,一次取栓成功占比为11/17。17例患者中,1例患者出现远端栓塞,经再次取栓后血管再通;未发生颅内出血。患者取栓后NIHSS评分2~20分,平均(9±5)分,与术前比较,差异有统计学意义(t=5.759,P<0.05)。术后90 d mRS评分≤2分者12例,预后良好占比为12/17。结论县级综合卒中中心使用Solitaire支架机械取栓联合Navien导管抽吸技术治疗前循环大血管闭塞是安全有效的。

Objective To investigate the safety and efficacy of Solitaire stent combined with Navien aspiration for large vessel occlusion of anterior circulation performed in county comprehensive stroke centers.Methods From March 2018 to December 2018,a total of 17 consecutive patients with large vessel occlusion of anterior circulation and treated with Solitaire stent combined with Navien catheter for mechanical thrombectory in Department of Stroke Center,the First People′s Hospital of Taicang were retrospectively recruited.Among the 17 patients,10 were males and 7 were females.The preoperative National Institutes of Health Stroke Scale(NIHSS)scores ranged from 8 to 22,with mean score 14±4.The occluded arteries included M1 segment of middle cerebral artery in 12 patients,bifurcation of middle cerebral artery in 1 patient and initial part of the internal carotid artery in 4 patients.Four patients were wake-up stroke and 1 patient was in-hospital stroke.The age,gender,onset-to-door time(ODT),door-to-needle time(DNT),door-to-puncture time(DPT),puncture-to-reperfusion time(PRT),changes of NIHSS score at 24 h after operation compared to preoperative baseline,successful recanalization of the Thrombolysis in Cerebral Infarction(TICI)classification 2b-3,operation-related complications and good prognosis of modified Rankin Scale(mRS)score≤2 at day 90 after operation were all documented.Results Among the 17 patients,5 patients were treated with endovascular thrombectomy bridging with intravenous thrombolysis and 12 patients with endovascular thrombectomy alone.The ODT ranged 1.0-5.5 h,with median 3.0(2.0,4.7)h;the DNT ranged 26-35 min,with mean 30±4 min;the DPT ranged 79-276 min,with mean 152±53 min;the PRT ranged 27-134 min,with mean 57±33 min.The thrombectomy ranged 1-3 times,with median 1(1,2)times.DSA examination was performed immediately after thrombectomy.Among 17 patients,2 patients achieved TICI 2a,5 patients achieved TICI 2b and 10 patients achieved TICI 3.The rate of successful recanalization was 15/17.The rate of successful recanalization by one-time thrombectomy was 11/17.One patient showed distal occlusion and was recanalized after additional thrombectomy.No intracranial hemorrhage occurred.The postoperative NIHSS ranged 2-20 points,with mean 9±5 points and it was significantly different from that of preoperative NIHSS(t=5.759,P<0.05).Twelve patients had mRS score≤2 at day 90 after operation,and the rate of good prognosis was 12/17.Conclusion Solitaire stent thrombectomy combined with Navien catheter aspiration in county comprehensive stroke centers is safe and effective for large vessel occlusion of anterior circulation.