机械取栓治疗急性大脑前动脉闭塞临床分析

Clinical analysis of mechanical thrombectomy in the treatment of acute anterior cerebral artery occlusions

目的探讨机械取栓治疗大脑前动脉闭塞的疗效和结局。方法回顾性分析2018-01—2020-06在徐州医科大学附属医院采用机械取栓治疗的7例急性大脑前动脉闭塞患者的临床资料,主要终点定义为在脑梗死溶栓治疗后血流分级(TICI)≥2b为血管再通,次要终点包括90 d改良的Rankin量表(mRS)评分和有无症状性颅内出血。结果本组患者中7例中4例为原发性栓塞,3例继发于介入治疗;平均发病年龄55.9岁(34~70岁),发病时NIHSS评分13.4分(8~18分);5例(71.4%)合并同侧大脑中动脉或对侧大脑前动脉闭塞;7例(100%)实现再通(TICI≥2b),发病到靶血管开通时间平均271.4 min(185~325 min);6例(85.7%)出现同侧大脑前动脉支配区的梗死灶;4例(57.1%)90 d m RS评分≤2分,3例(42.9%)90 d m RS评分≥3分,其中1例(14.3%)mRS评分6分;1例(14.3%)出现脑血管痉挛,1例(14.3%)患者发生颅内出血。结论尽管可以在急性大脑前动脉闭塞患者中考虑机械取栓治疗,但需要进一步的临床试验确定机械取栓对急性大脑前动脉闭塞的疗效。

Objective To explore the presentation,treatment,and the outcomes of anterior cerebral artery(ACA)occlusions in patients undergoing mechanical thrombectomy.Methods The clinical data of a total of seven patients with acute anterior cerebral artery occlusions,who were admitted to Affiliated Hospital of Xuzhou Medical University during January 2018 to December 2019 to receive mechanical thrombectomy,were retrospectively analyzed.The primary end point was defined as achieving a thrombolysis in cerebral infarction(TICI)score≥2 b.The secondary end point included the 90-day modified Rankin Scale(m RS)score and symptomatic intracranial hemorrhage.Results tients,secondary to an interventional maneuver in three patients.Five were male and two was female,and mean age at onset was 55.9 years(range:34-70 years).The NIHSS score at admission ranged from 8 to 18 and the median was 13.4.Five patients(71.4%)with a primary ACA occlusion had multiple occlusions in the ipsilateral middle cerebral arteries(MCAs)or contralateral ACA.Recanalization(TICI≥2 b)was achieved in seven patients(100%).The median time from onset to recanalization(ORT)was 271.4 minutes(range 185-325 minutes).Six patients(85.7%)had ipsilateral infarction of the ACA territory.Two patients(28.6%)had a 90-day mRS score≤2,five patients(71.4%)had a 90-day mRS score≥3,and one paqtients(14.3%)had an m RS score of 6.One patient(14.3%)developed vasospasms,and one patient(14.3%)had intracranial hemorrhage.Conclusion Although mechanical thrombectomy can be considered in patients with ACA occlusions,our data suggest that future clinical trials are needed to determine the efficacy of mechanical thrombectomy for ACA occlusions.