急性缺血性卒中血管内治疗的术式转换和补救

Material Selection and Pattern Transformation in Endovascular Rescue Treatment for Acute Ischemic Stroke

急性缺血性卒中血管内治疗取得良好预后的基础是及时恢复缺血区脑组织的有效灌注,即达到前向血流mTICI 2b/3级。当使用取栓支架取栓、抽吸导管取栓、球囊/支架成形术等方法开通闭塞血管过程中,未能达到缺血区有效灌注时,应仔细分析原因,再度审视手术路径、病变性质、闭塞血管特点、血栓性状及负荷量等因素,避免不必要的重复操作,减少手术延误,适时转换手术方式,更换手术材料,或辅以药物等可行的补救措施,尽快恢复缺血区有效灌注。

The basis of achieving good prognosis after endovascular treatment of acute ischemic stroke(AIS)is to restore the effective reperfusion in ischemic area,which is usually defined as a mTICI score of 2b or 3.When acceptable recanalization can not be achieved using single material such as stent retriever/aspiration catheter/balloon or stent angioplasty for thrombectomy,the characteristics of the target vessel and pathway,lesions nature,nature and load of thrombus should be re-evaluated,which can guide inventionists to make decisions for changing operation strategy and selecting appropriate material to make rescue therapy,with intra-arterial drug if necessary.