择期植入动脉支架治疗机械取栓后颅内靶血管残余重度狭窄

Selective stent implantation for treatment of severe residual stenosis of intracranial target artery after successful mechanical thrombectomy

目的探讨对机械取栓成功后颅内靶血管残余重度狭窄患者行择期动脉支架植入治疗的可行性。方法对4例成功机械取栓后颅内靶血管残余重度狭窄患者行择期动脉支架植入术。结果取栓术后4例闭塞血管均成功复流,靶血管均残余≥70%的重度狭窄,但可维持稳定前向血流。2例取栓术后72 h内MRI显示脑梗死面积较大,分别于取栓后48天和27天行支架植入;2例脑梗死面积小且神经功能恢复良好,分别于取栓术后12天和4天行支架植入。支架释放后4例血流均通畅,未见并发症,术后90天改良Rankin评分(mRS)均≤2;末次随访时支架位置均良好,血管通畅。结论对于机械取栓成功后靶血管残余重度狭窄,根据取栓后脑梗死面积及神经功能恢复情况择期植入动脉支架是相对安全有效的治疗方案。

Objective To investigate the feasibility of selective stent implantation for treatment of severe residual stenosis of intracranial target artery after successful mechanical thrombectomy(MT).Methods Selective stent implantation was successfully performed for treatment of severe residual stenosis of the intracranial target artery after MT in 4 patients,and the data of patients were analyzed retrospectively.Results The occluded arteries of 4 patients were all successfully recanalized after MT,and all the target arteries remained severe stenosis(≥70%)with antegrade blood flow stable.Two patients with major acute infraction on MRI within 72 h underwent stent implantation 48 days and 27 days after thrombectomy,while the other two with minor infraction and little neural deficits underwent stent implantation 4 days and 12 days after thrombectomy,respectively.The blood flows were all satisfying after stenting,no complication occurred,and modified Rankin scale(mRS)of all patients were≤2 after 90 days.No stent migration was observed at the end of follow-up,and all target arteries remained patent.Conclusion Selective stent implantation is an alternative,relatively safe and effective treatment method for residual severe intracranial stenosis after the reexamination of cerebral infarction and the neurological function.