Solitaire AB支架机械取栓治疗急性基底动脉闭塞的疗效分析

Efficacy of mechanical thrombectomy with retrievable Solitaire AB stent in acute basilar artery occlusion

目的观察急性基底动脉闭塞患者行支架机械取栓治疗的疗效和安全性。方法浙江省台州医院神经内科自2016年12月至2019年10月共收治急性基底动脉闭塞患者25例,对发病时间在4.5 h内且具有静脉溶栓适应证者,先行静脉溶栓治疗,同时联合Solitaire AB支架机械取栓治疗;对不适合静脉溶栓治疗或发病时间在4.5~24 h的患者,给予单纯Solitaire AB支架机械取栓或结合球囊扩张及支架植入治疗,术后90 d通过改良Rankin量表(mRS)评分判断患者的预后。回顾性分析上述患者的临床资料和疗效,并比较其中心源性栓塞型与大动脉粥样硬化型患者临床资料和预后的差异。结果24例患者血管成功再通,1例患者血管再通失败。术后90 d随访时患者预后良好11例,预后不良8例,死亡6例。心源性栓塞型患者的闭塞部位为基底动脉上段4例、中段10例、下段0例,大动脉粥样硬化型患者的闭塞部位为基底动脉上段0例、中段6例、下段5例,心源性栓塞型与大动脉粥样硬化型患者基底动脉闭塞部位的分布差异有统计学意义(P<0.05),但术后90 d mRS评分差异无统计学意义(P>0.05)。结论急性基底动脉闭塞患者行支架机械取栓治疗安全可行。急性基底动脉闭塞部位与闭塞病因有关。

Objective To observe the efficacy and safety of mechanical thrombectomy with retrievable stent in patients with acute basilar artery occlusion(ABAO).Methods Twenty-five patients with ABAO admitted to our hospital from December 2016 to October 2019 were chosen in our study.In patients who were eligible for intravenous thrombolysis and had onset within 4.5 h,mechanical thrombectomy with Solitaire AB stent was performed besides intravenous thrombolysis.In patients who had contraindications for intravenous thrombolysis or had onset within 4.5-24 h,mechanical thrombectomy with Solitaire AB stent or mechanical thrombectomy with Solitaire AB stent combined with balloon dilatation and stenting were performed.The prognoses of the patients were determined by modified Rankin scale(mRS)90 d after surgery.The clinical data and efficacy of the patients were analyzed retrospectively,and the differences in clinical data and prognoses between patients with cardiogenic embolization and those with large artery atherosclerosis were compared.Results Twenty-four patients had successful recanalization,and one failed.Follow-up for 90 d showed that 11 patients had good prognosis,8 had poor prognosis,and 6 died.In patients with cardiogenic embolization,the occlusion sites were located in the upper segment of the basilar artery(n=4)and the middle segment of the basilar artery(n=10);in patients with large-artery atherosclerosis,occlusion sites were located in the middle segment of the basilar artery(n=6)and the under segment of the basilar artery(n=5);the distribution of basilar artery occlusion sites between patients with cardiogenic embolization and those with large artery atherosclerosis was statistically different(P<0.05).The mRS scores 90 d after surgery showed no significant differences(P>0.05).Conclusion Mechanical thrombectomy with retrievable stent is safe and feasible for patients with ABAO,and the occlusion sites of the basilar artery in ABAO may indicate the etiology of occlusion.