基于一种新闭塞分型系统的大脑中动脉非急性期闭塞血管内再通治疗的临床研究

Endovascular recanalization for non-acute middle cerebral artery occlusion based on a new cerebral angiography classification

目的探讨新的大脑中动脉非急性期闭塞脑血管造影分型系统对大脑中动脉非急性期闭塞血管内再通治疗的血管再通率及围手术期并发症的影响。方法回顾性分析2015年1月至2019年10月首都医科大学附属北京天坛医院神经介入中心连续收治的30例行血管内再通治疗的症状性大脑中动脉非急性期闭塞患者的临床资料。以DSA检查为基础,结合术前CT血管成像、MR血管成像及高分辨率MRI等神经影像检查手段综合判断,依据闭塞部位、闭塞长度及侧支循环等神经影像学特征将大脑中动脉闭塞分为三型(Ⅰ、Ⅱ、Ⅲ型)。对所有患者一般资料、病变分型、血管再通率和围手术期并发症等情况进行数据收集,采用脑梗死溶栓(TICI)评估系统评估血管开通情况。术后30 d进行门诊随访或头部CT或MR检查,记录是否发生不良事件(卒中/死亡)。对三型间各资料进行组间比较。结果30例患者中,Ⅰ型9例,Ⅱ型15例,Ⅲ型6例。术后25例(83.3%)患者血管成功再通。Ⅰ型、Ⅱ型病变患者较Ⅲ型患者有更低的围手术期并发症发生率(0、2/15比3/6)、血管夹层发生率(0、1/15比2/6),差异均有统计学意义(χ^2值分别为3.931、3.865,P值分别为0.047、0.049),以及较高的血管再通率(9/9、13/15比3/6)和更低的术后30 d内出血性卒中发生率(0、1/15比1/6)趋势,但差异均无统计学意义(χ2值分别为3.771、1.522,P值分别为0.052、0.217)。结论根据新的脑血管造影分型系统,综合评估病变的闭塞时间、长度以及侧支循环的神经影像学特征,有利于筛选非急性大脑中动脉闭塞血管内再通治疗的适合患者,综合权衡血管内再通治疗的风险获益。

Objective To evaluate the effects of the new cerebral angiography classification on the rates of recanalization and perioperative complication of endovascular recanalization for non-acute middle cerebral artery(MCA)occlusion.Methods A total of 30 patients with symptomatic non-acute MCA occlusion treated by endovascular recanalization in Beijing Tiantan Hospital from January 2015 to September2019 were enrolled retrospectively.According to the new cerebral angiography classification system,These patients were divided into 3 types.The rate of recanalization,surgery details,and periprocedural complications,and follow-up results were collected and evaluated.The primary adverse event was any stroke or death within 30 days.Results Among 30 cases,25 cases(83.3%)had successful recanalization.In this new classification system,there were 9 cases of typeⅠ,15 cases of typeⅡ,6 cases of typeⅢ.Compared with typeⅢlesion,the patients with typeⅠand typeⅡlesions had lower rates of total perioperative complication(0,2/15 vs.3/6,P=0.047),vessel dissection(0,1/15 vs.2/6,P=0.049),and any stroke and death(0,1/15 vs.1/6,P=0.217),and had higher revascularization rate(9/9,13/15 vs.3/6,P=0.052).Conclusion It is beneficial to select patients with non-acute middle cerebral artery occlusion and balance the risk and benefit of endovascular recanalization according to the neuroimaging characteristics of lesions and the time course of occlusion assessed by the new cerebral angiography classification system.