双支架取栓治疗难治性颅内大动脉分叉处急性闭塞的疗效观察

Efficacy of double stent-retriever thrombectomy in the treatment of refractory acute intracranial macrovascular occlusion at bifurcation

目的探讨双支架取栓治疗难治性颅内大动脉分叉处急性闭塞的有效性及安全性。方法回顾性分析盱眙县人民医院神经内科和江苏省人民医院介入放射科自2019年5月至2021年10月行双支架取栓治疗难治性颅内大动脉分叉处急性闭塞患者的临床及影像学资料,评估患者的血管再通情况、手术并发症及临床预后。比较患者术前及出院时美国国立卫生研究院卒中量表(NIHSS)评分,采用改良Rankin评分(mRs)评价患者术后90 d的临床预后。结果本组共纳入11例患者,均为单支架取栓失败后改用双支架进行补救,9例(81.8%)患者成功再通(改良脑梗死溶栓分级为2b~3级),2例患者再通失败。4例患者术后发生症状性颅内出血。本组患者出院时NIHSS评分的中位数[12(2,20)分]较术前[16(8,21)分]明显降低,差异具有统计学意义(P=0.012)。术后随访90 d,2例患者死亡(mRs 6分),3例患者严重残疾(mRs 5分),1例患者重度残疾(mRs 4分),1例患者中等残疾(mRs 3分),4例患者良好(mRs≤2分)。结论双支架取栓技术治疗难治性颅内大血管分叉处急性闭塞安全、有效,血管再通率高,可以作为单支架取栓不成功的补救措施。

Objective To investigate the effectiveness and safety of double stent-retriever thrombectomy in the treatment of acute intracranial macrovascular occlusion at bifurcation.Methods The clinical and imaging materials of patients with acute intracranial macrovascular occlusion at the bifurcation treated with double stent-retriever thrombectomy from May 2019 to October 2021 in the Neurology Department of Xuyi County People􀆳s Hospital and Interventional Radiology Department of Jiangsu Provincial People􀆳s Hospital were retrospectively analyzed.The recanalization rate and complications were determined and the clinical outcomes were assessed.Also,neurological functions of the patients before treatment and discharge from hospital,measured by National Institute of Health stroke scale(NIHSS)score,were compared via Wilcoxon test and the clinical outcomes were assessed by modified Rankin score(mRs)at 90 d after treatment.Results A total of 11 patients were treated with double stents after single stent thrombectomy failed,9 patients resulted in successfully recanalization(modified thrombolysis in cerebrai infarction score of 2b to 3),and 2 patients failed.There were 4 patients with symptomatic intracranial hemorrhage occurred after operation.Compared with preoperative conditions,the NIHSS score discharge from hospital was markedly lower(12 vs 16,P=0.012).At 90 d,2 patients died(mRs 6),3 patients seriously disabled(mRs 5),1 patient moderately seriously disabled(mRs 4),1 patient resulted in moderate outcome(mRs 3)and the other 4 patients achieved good outcome(mRs 0-2).Conclusion Double stent-retriever thrombectomy is safe and effective in the treatment of acute intracranial macrovascular occlusion at bifurcation with high vascular recanalization rate.It can be used as a rescue strategy for the failure of single stent thrombectomy.