双支架联合中间导管抽吸技术补救性治疗急性心源性颅内大血管闭塞的疗效分析

Analysis of the efficacy of double-stent combined with intermediate catheter aspiration technology in the rescue treatment of acute cardiogenic intracranial large vessel occlusion

目的 探讨双支架联合中间导管抽吸技术在急性心源性颅内大血管闭塞补救治疗中的有效性及安全性.方法 回顾性分析郑州大学附属洛阳中心医院神经介入科2019年1月至2023年6月采用双支架技术进行补救性治疗的心源性急性颅内大血管闭塞患者的临床资料,共20例.均为应用常规取栓及补救措施失败3次以上的患者.术后即刻评估闭塞血管的开通情况,改良脑梗死溶栓分级(mTICI)≥2b级为再通良好;术后90 d采用改良Rankin量表评分(mRS)评估神经功能缺损情况,≤2分为预后良好,3~6分为预后不良.结果 20例患者中,17例血管再通良好,1例血管部分再通(mTICI 2a级),2例血管开通失败.发生血栓逃逸1例,血管痉挛10例,蛛网膜下腔出血3例,症状性脑出血3例.术后90 d随访,6例预后良好;14例预后不良,其中mRS3~5分者10例,mRS6分(死亡)者4例.结论 双支架联合中间导管抽吸技术作为急性心源性颅内大血管闭塞的补救性治疗措施可使大部分血管再通,手术相关并发症经治疗多可恢复.

ObjectiveTo investigate the efficacy and safety of double-stent combined with intermediate catheter aspiration technique as a rescue treatment in the acute cardiogenic intracranial large vessel occlusion.MethodsThe clinical data of 20 patients with acute cardiogenic intracranial large vessel occlusion who received rescue treatment with double stents from January 2019 to June 2023 in the Department of Neurointervention,Luoyang Central Hospital Affiliated to Zhengzhou University were retrospectively analyzed.Conventional thrombectomy and rescue measures failed more than 3 times in all patients before the application of the two-stent combined with intermediate catheter aspiration technique remedy.The recanalization of occluded blood vessels was evaluated immediately after surgery.Modified Thrombolysis in Cerebral Infarction(mTICI)grade≥2b indicated good recanalization.The modified Rankin Scale(mRS)was used to evaluate neurological deficits 90 days after surgery,with≤2 points indicating good outcome and 3-6 indicating poor outcome.ResultsAmong the 20 patients,17 patients had good vessel recanalization(mTICI≥grade 2b),1 patient had partial vessel recanalization(mTICI grade 2a),and 2 patients had failed vessel recanalization.Thrombus escape occurred in 1 case,vasospasm in 10 cases,subarachnoid hemorrhage in 3 cases,and symptomatic cerebral hemorrhage in 3 cases.After 90 days of follow-up,6 cases had a good outcome;14 cases had a poor outcome,including 10 cases with mRS of 3 to 5 points and 4 cases with mRS of 6 points(death).ConclusionAs a rescue treatment for acute cardiogenic intracranial large blood vessel occlusion,double stents combined with intermediate catheter aspiration can recanalize most of the blood vessels,and most of the surgery-related complications can be recovered after treatment.