大脑中动脉M1段亚急性及慢性闭塞介入机械再通及支架置入的尝试与初步评价

Mechanical recanalization for symptomatic subacute and chronic middle cerebral artery occlusion

目的对症状性大脑中动脉M1段亚急性及慢性闭塞患者行介入机械再通及支架置入术,评价其可行性与疗效。方法 6例大脑中动脉M1慢性、亚急性闭塞患者行介入机械再通及支架置入术。术前CTA明确大脑中动脉主干闭塞,术后评价症状改善、血流改善情况,记录围手术期并发症,复查血管通畅情况并随访其疗效。结果 6例患者7根闭塞大脑中动脉,5例6根闭塞动脉(85.7%)成功开通。4例术后第2天症状即改善;2例术后症状加重,其中1例3d后症状明显改善,另1例(即未开通病例)2周后恢复至术前水平。术后30d内无死亡、再发卒中及短暂性脑缺血发作等事件发生。6例患者平均随访4.2个月,无病情加重、反复或死亡事件发生。结论对于大脑中动脉M1段亚急性及慢性闭塞的患者,在严格筛选病例的前提下,采取介入机械再通的方法在技术上是可行的,能够改善缺血症状,促进患者相应功能障碍的恢复。但其远期疗效还有待大样本长期随访证实。

Objective To try to treat symptomatic patients with subacute and chronic in middle cerebral artery (M1) occlu-sion by mechanical recanalization and to assess its feasibility and short-term effects .Methods Six patients have undergone the operation .Preoperative CTAs were used to verify middle cerebral artery occlusion .Improvement of syndrome and blood flow were evaluated after operation .Perioperative complications ,vascular patency and follow-up review of its efficacy were recor-ded .Results Seven occlusive middle cerebral arteries (M1) in 6 patients were operated .6 occlusive middle cerebral arteries (M1) in 5 patients (85 .7% ) were successfully recanalizated .4 patient's symptoms improved the next day ;2 patients'symptoms exacerbated ,of which one was significantly improved after 3 days .Another patients'symptoms recovered to preoperative levels in 2 weeks .No patients died after surgery .No recurrence of stroke and transient ischemic attack event occured .6 cases of pa-tients with an average follow-up of 4 .2 months ,no worsening of condition ,recurrence or death occurred .Conclusion For pa-tients with subacute and chronic total occlusion of the middle cerebral artery (M1) ,on the premise of strict screening cases ,me-chanical recanalization was technically feasible .It is able to improve outcomes in ischemic symptoms and promote the dysfunc-tion recovery .But its long-term effect remains to be seen in large samples and confirmed in long-term follow-up studies .