大脑中动脉M1段亚急性闭塞血管内再通治疗的评价及影像评估的应用价值

Evaluation on endovascular revascularization in subacute occlusion of M1 segment of cerebral middle artery and the application value of imaging

目的评估大脑中动脉M1段亚急性闭塞血管内再通治疗的可行性、安全性、有效性以及影像评估与手术并发症的风险及预后的相关性。方法回顾性分析2018年1月至2019年12月期间本院神经介入治疗中心26例颅内大脑中动脉M1段亚急性闭塞患者血管内再通治疗的临床资料,男性20例,女性6例,中位年龄61.00岁。采用磁共振动脉自旋标记成像(ASL)以及血管壁高分辨磁共振成像(VM-HRMRI)、美国国立卫生研究院卒中量表(NIHSS)和改良Rankin量表(mRS)评价血管内再通治疗技术的成功率、围手术期并发症及术后神经功能恢复和血管情况。结果26例患者中,24例成功开通,2例术中导丝不能通过而再通失败。手术并发症7例:2例为脑出血,VM-HRMRI显示闭塞血管周围烟雾状血管形成,局部脑血流量(rCBF)为(18.9±0.1)%;4例为造影剂外渗,rCBF为(64.5±11.8)%;1例为症状性末梢栓塞事件。18例无造影剂外渗的患者的rCBF为(37.9±11.9)%。2例并发严重的脑出血转至外科手术的患者失访;其他22例患者术后3~6个月随访结果显示2例患者出现手术血管再闭,4例发生病变血管的轻微再狭窄,余16例均无出现血流动力学上的再狭窄,以上患者均无再发卒中和短暂性脑缺血发作事件。2例再闭塞的患者术后90 d的mRS评分增加到4分,NIHSS评分增加,9例患者NIHSS和mRS评分无明显改善,其余13例患者mRS评分为0~1分,NIHSS评分明显改善。结论对于大脑中动脉M1段亚急性闭塞的患者,在严格筛选的前提下,采取血管内再通治疗是安全的,短期内可以改善患者的神经功能,但远期疗效需要长期随访证实。

Objective To evaluate the feasibility,safety,and efficacy of endovascular revascularization for subacute occlusion of M1 segment of middle cerebral artery,and the correlations between imaging evaluation,risk of surgical complications,and prognosis.Methods The clinical data of 26 patients with subacute occlusion of M1 segment of middle cerebral artery treated with endovascular revascularization,enrolled in the Neurointerventional Therapy Center of our hospital from January 2018 to December 2019 were retrospectively analyzed,including 20 males and 6 females,with a median age of 61.00 years old.The success rate of endovascular revascularization,perioperative complications,and postoperative neurological recovery and vascular condition were evaluated by magnetic resonance arterial spin labeling(ASL),high-resolution magnetic resonance imaging of vascular wall(VM-HRMRI),National Institutes of Health Stroke Scale(NIHSS),and modified Rankin Scale(mRS).Results Among the 26 patients,24 cases got recanalized and 2 cases failed to pass through the guide wire during the operation.Intraoperative complications occurred in 7 cases:there were 2 cases of severe cerebral hemorrhage,VM-HRMRI showed smoky angiogenesis around the occluded vessel,and the regional cerebral blood flow(rCBF)was(18.9±0.1)%;there were 4 cases of contrast agent extravasation,and the rCBF was(64.5±11.8)%;there was 1 case of symptomatic distal embolism.The rCBF of 18 patients without contrast agent extravasation was(37.9±11.9)%.Two patients with severe cerebral hemorrhage who were transferred to surgery were lost to follow-up.The other 22 patients completed vascular examination and clinical follow-up of 3-6 months after surgery,among whom 2 patients had reocclusion,4 patients had slight restenosis of the diseased vessels,the remaining 16 patients had no hemodynamic restenosis,and all 22 patients had no recurrence of stroke and transient ischemic attack.In 24 recanalized cases,2 patients with reocclusion had a mRS score increased to 4 and an increased NIHSS score on the postoperative 90th day,9 patients had no significant improvement in NIHSS and mRS scores,the mRS score of the remaining 13 patients was 0-1 and the NIHSS score improved significantly.Conclusions For patients with subacute occlusion of M1 segment of cerebral middle artery,under the premise of strict screening,endovascular revascularization therapy is safe,which can improve the neurological function of patients in the short term,but the long-term efficacy needs to be confirmed by long-term follow-up.