多模式影像指导下超时间窗的前循环大血管闭塞急性脑梗死患者血管内治疗单中心临床经验

Intravascular therapy of acute cerebral infarction patients with anterior circul-ation great vessel occlusion under the guidance of multi-mode imaging with time window single center clinical experience

目的探讨多模式影像指导下前循环大血管闭塞的超时间窗急性脑梗死患者血管内治疗的有效性和安全性。方法选取2018-02—2018-10收治的10例超时间窗的前循环大血管急性闭塞患者的临床资料进行分析。观察患者年龄、是否有相关疾病及发病到血管内治疗的时间、闭塞血管部位、治疗效果及并发症等。采用溶栓试验(mTICI)分级标准评估血管再通的情况,观察术前、术后24 h、14 d神经功能,采用美国国立卫生研究院卒中量表(NIHSS)评分及改良Rankin量表(mRS)评价患者术后90 d预后。根据患者术后90 d的预后情况将入组患者分为预后良好组(mRS≤2分)和预后不良组(mRS≥3分)。结果10例患者血管再通率为100%,术后1例出现无症状蛛网膜下腔出血,2例出现灶内渗血但临床症状无加重,1例血管再次闭塞,1例出血脑疝死亡,治疗后14 d NIHSS评分(5±2)分,低于入院时的(10.5±6.5)分,差异有统计学意义(P<0.01)。90 d预后良好9例(90%),死亡1例(10%)。结论在严格影像导引下对超时间窗的前循环大血管闭塞介入治疗是安全、有效的,能明显改善患者临床预后。

Objective To investigate the efficacy and safety of intravascular therapy for acute cerebral infarction patients with anterior circulation great vessel occlusion under the guidance of multi-mode imaging over time window.Methods 10 patients with acute cerebral infarction with anterior circulation great vessel occlusion over the time window from February 2018 to October 2018 were selected.The age of the patients,related basic diseases,time from the onset to the beginning of intravascular therapy,occlusion part,treatment effect and complications were observed.Cerebral infarction thrombolysis test(mTICI)was used for grading the assessment of vascular recanalization,preoperative and postoperative neurological function at 24h and 14d were observed,and the NIHSS score and modified Rankin scale(mRS)were used to evaluate the prognosis at 90 days.According to the prognosis,the patients were divided into good prognosis(mRS less than or equal to 2 points)and poor prognosis(mRS greater than or equal to 3 points).Results The rate of vascular recanalization was 100%in 10 patients,1 patient presented asymptomatic subarachnoid hemorrhage,2 patients presented focal bleeding without worsening clinical symptoms,1 patient vascular reocclusion,and 1 patient died of hemorrhagic cerebral hernia.The NIHSS score at 14 days after treatment(5±2)was lower than that at admission(10.5±6.5),and the difference was statistically significant(P<0.01).At 3 months,9(90%)patients had a good prognosis and 1(10%)patient died.Conclusion It is safe,effective and can improve the clinical prognosis of patients with anterior circulation occlusion under strict imaging guidance.