症状性颅内前循环大动脉非急性闭塞血管内治疗的可行性分析

Analysis of Feasibility of Endovascular Therapy for Non-acute Intracranial Anterior Circulation Large Vessel Occlusion

目的评估血管内治疗症状性颅内前循环大动脉非急性闭塞的可行性及有效性。方法回顾性分析2016年1月-2019年10月青岛大学附属医院神经内科采用血管内治疗的颅内前循环大动脉非急性闭塞患者的临床资料。评价血管内治疗的血管再通率、术后并发症、临床预后,并随访患者血管再狭窄及卒中复发情况。结果共纳入22例患者,血管内治疗后,20例(90.9%)患者闭塞的血管成功再通,术后并发症3例(13.6%),其中1例为术中蛛网膜下腔出血,1例为术后出血转化,1例术后出现癫痫发作;血管再通的患者中单纯球囊扩张术治疗7例,中位血管残余狭窄率为12.4%(8.6%~20.5%),球囊扩张+自膨式支架治疗10例,中位血管残余狭窄率为10.4%(6.2%~17.8%),两种治疗方法的血管残余狭窄率差异无统计学意义。血管成功再通患者出院时临床症状改善8例(40.0%),无明显变化12例(60.0%),无症状加重患者。术后随访时间为19(12~29)个月,mRS评分良好者12例(60.0%),1例(5.0%)再发TIA,DSA显示支架内再狭窄,给予球囊扩张术治疗后症状好转。结论血管内治疗症状性颅内前循环大动脉非急性闭塞是安全可行的,能够改善患者的缺血症状,并且术后卒中复发率较低。

Objective To explore the feasibility and effectiveness of endovascular therapy for symptomatic non-acute intracranial anterior circulation large artery occlusion.Methods The data of patients with non-acute intracranial anterior circulation large artery occlusion who underwent endovascular treatment in Department of Neurology of the Affiliated Hospital of Qingdao University from January 2016 to October 2019 were retrospectively analyzed.The recanalization rate,postoperative complications,clinical prognosis(including mRS score,restenosis and ischemic events)were evaluated.Results A total of 22 patients were included.20 cases(90.9%)achieved successfully recanalization.3 cases(13.6%)had postoperative complications,including one case with intraoperative subarachnoid hemorrhage,one case with hemorrhagic transformation and one case with epileptic seizure.For the patients who achieved successful recanalization,7 patients underwent balloon angioplasty,and the rate of moderate residual stenosis was 12.4%(8.6%-20.5%);10 patients underwent balloon angioplasty and self-expanding stenting,and the rate of moderate residual stenosis was 10.4%(6.2%-17.8%);there was no statistical difference in the rate of residual stenosis between the two treatment methods.After successful recanalization,the clinical symptoms improved in 8 cases(40.0%)and no change in 12 cases(60.0%)and no worsen case.12 cases(60.0%)had a mRS score of 0-1 within the follow-up of 19(12-29)months,1 case(5.0%)had recurrent TIA due to in-stent restenosis,and the symptoms improved after balloon dilatation.Conclusions Endovascular therapy for symptomatic non-acute intracranial anterior circulation large artery occlusion is safe and feasible,which can improve ischemic symptoms and reduce the risk of recurrent stroke.