伴有大动脉狭窄的脑梗死行支架取栓和静脉溶栓的对比研究

目的比较支架取栓和静脉溶栓治疗伴有大动脉狭窄的脑梗死的疗效及安全性。方法回顾性分析上海市浦东新区人民医院神经内科和神经外科自2015年9月至2017年3月收治的38例的伴有大动脉狭窄的急性期脑梗死的临床资料,依据治疗方法不同分为静脉溶栓组(19例)和支架取栓组(19例)。静脉溶栓组患者静脉给予重组组织型纤溶酶原激活物(rt-PA)溶栓治疗,支架取栓组患者给予Solitaire支架取栓治疗。对比2组患者的血管再通率[以脑梗死溶栓等级系统(TICI)≥2B级为再通]、24h美国国立卫生院卒中量表(NIHSS)评分改善率(较治疗前减少≥4分或症状完全消失)、90d后改良Rankin量表(mRS)评分改善情况(≤2分定义为神经功能良好)、脑出血情况(参照ECASSⅡ标准)及90d死亡率。结果支架取栓组18例(94.74%)患者血管再通,6例(31.58%)患者24hNIHSS评分改善,4例(21.05%)患者90d后mRS评分良好;静脉溶栓组12例(63.16%)患者血管再通,10例(52.63%)患者24hNIHSS评分改善,12例(63.16%)患者90d后mRS评分良好;支架取栓组2例(10.53%)患者发生出血性梗死,1例患者发生症状性脑出血,90d内1例患者死亡;静脉溶栓组2例(10.53%)患者发生出血性梗死,90d内1例患者死亡,其中,血管再通率和90d后mRS评分2项指标差异有统计学意义(P0.05)。结论对伴有大动脉狭窄急性期脑梗死的治疗中,支架取栓较静脉溶栓疗效具有更好的血管再通率,但是静脉溶栓具有更好的90d后mRS评分良好率。     

急性基底动脉远端闭塞的双支架取栓策略

目的探讨双支架取栓技术治疗急性基底动脉远端闭塞的安全性和疗效。方法回顾性分析2015年1月—2019年5月本院脑血管病中心采用双支架取栓术治疗的5例急性基底动脉远端闭塞患者的影像学及临床资料,包括改良脑梗死溶栓分级(m TICI)、术后24 h及7 d的中位美国国立卫生研究院卒中量表(NIHSS)评分、围术期并发症以及90 d改良Rankin量表(mRS)评分。结果本组5例患者中,3例患者经单支架多次取栓失败后改用双支架取栓,2例直接使用双支架取栓。所有闭塞血管均再通成功,m TICI达到2b级至3级。术后3D-CT未发现颅内出血,术后24 h及7 d的中位NIHSS评分依次为9.8、7.4分。1例患者术后死于肺部感染。随访3个月,3例患者90 d mRS评分≤2分,1例90 d mRS评分 2分。结论双支架取栓技术治疗急性基底动脉远端闭塞安全、有效,血管再通率高,可以作为常规取栓不成功的补救措施。     

Solitaire AB支架治疗急性脑血管闭塞的护理

目的探讨急性脑血管闭塞患者Solitaire AB支架机械取栓手术治疗后的效果和护理方法。方法回顾性总结16例急性脑血管闭塞行机械取栓治疗的患者资料。按照TICI评估血管再通情况,术后加强对血压、生命体征的监测、心律失常的监护、脑血管痉挛的防治、呼吸功能的维护、足背动脉及手术创口的观察等。对于术前及术后1周进行NIHSS评分及ADL评分,出院3月后采用门诊或电话随访对患者进行mRS评分。结果 14例患者闭塞血管达到充分再通标准,再通率为87.5%;其中10例患者闭塞血管完全再通,2例患者闭塞血管开通失败。14例患者未发生术后并发症,2例患者术后出现脑出血。14例患者术后临床症状较治疗均有前有不同程度改善,于3~4周内康复出院,术前与术后不同时间的NIHSS评分、ADL评分比较差异有统计学意义(P0.01)。随访3个月后,临床结局预后良好患者12例(mRS评分≤2分),2例mRS评分3分,2例mRS评分5分。结论 Solitaire AB支架治疗急性脑血管闭塞能够获得良好的效果,预后恢复良好。术后加强护理,能够提高手术成功率,严格控制血压,密切监护生命体征情况,是确保手术成功的重要环节。     

阿替辅酶静脉溶栓桥接Solitaire AB支架取栓术治疗急性脑梗死23例疗效观察

目的评价阿替辅酶静脉溶栓桥接Solitaire AB支架取栓术治疗急性脑梗死的临床疗效。方法选取我院2015年6月~2017年6月收治的73例急性脑梗死患者作为研究对象,根据治疗方法的不同分为研究组(静脉溶栓桥接取栓,n=23)、对照1组(同期直接取栓,n=12)和对照2组(同期静脉溶栓未取栓,n=38),评价三组临床疗效。结果三组治疗前NIHSS评分、Barthel评分均无明显差异(P0.05),研究组治疗后NIHSS评分较对照1组和对照2组低(P0.05),Barthel评分较对照1组和对照2组高(P0.05),对照1组、对照2组治疗后1周的NIHSS评分、Barthel评分比较无明显差异(P0.05)。结论阿替辅酶静脉溶栓桥接Solitaire AB支架取栓术治疗急性脑梗死疗效可靠,能有效改善患者预后。     

静脉溶栓桥接血管内取栓的护理配合

目的:探讨静脉溶栓桥接Solitaire支架取栓治疗急性脑血管闭塞性疾病的护理配合要点。方法:对2014年6月~2015年10月我院收治的15例静脉溶栓桥接Solitaire支架取栓开通颅内闭塞大血管的患者的护理配合方法进行总结。结果:本组15例患者大血管成功获得开通,其中2例患者取栓3次后未能取出栓子,给予Solitaire支架成形获得满意效果。仅2例患者出现症状性的颅内出血。临床转归方面,死亡2例。90 d后随访临床结局优良患者9例。结论:快速的术前护理准备、术中积极而熟练地护理配合是协助介入医师治疗急性脑血管病的重要保障,提高治疗成功率,减轻患者严重并发症的保证。     

Solitaire支架取栓再通后经解脱 治疗医源性颈动脉夹层1例

<正>急性颅内大血管闭塞发病急、病情重,急诊血管内治疗能在有效时间内再通血管,挽救患者生命。本文报告1例急性大脑中动脉闭塞患者接受静脉溶栓桥接血管内治疗：首选直接抽吸技术取栓失败,采用Solitaire取栓支架补救性拉栓实现血管再通后,靶血管近端出现医源性夹层,而后解脱Solitaire支架实现夹层贴壁治疗,最终获得满意疗效。     

Solitaire支架取栓治疗急性缺血性卒中的效果及对预后的影响

目的分析Solitaire支架取栓在急性缺血性卒中治疗中的效果以及对患者预后的影响。方法选取2016年9月至2019年7月在河南科技大学附属许昌市中心医院治疗的300例急性缺血性卒中患者,将同意行机械取栓患者168例作为观察组,不同意机械取栓患者132例作为对照组,分别采取Solitaire支架取栓、静脉溶栓治疗,比较两组血管再通率、NIHSS评分及mRS评分。结果观察组血管再通率(100%,168/168)明显高于对照组(44. 70%,59/132,P 0. 05);治疗后7 d,观察组患者的NIHSS评分明显低于对照组(P 0. 05);治疗后3个月,观察组mRS评分2分比例明显高度对照组,mRS评分低于对照组(P 0. 05)。结论对急性缺血性卒中患者采取Solitaire支架取栓治疗血管再通率较高,可减轻患者神经功能损伤,改善预后。     

Solitaire AB支架机械取栓治疗急性颅内动脉闭塞的护理

目的探讨Solitaire AB支架机械取栓治疗急性颅内动脉闭塞的护理。方法回顾性分析36例采用Solitaire AB支架机械取栓术治疗的急性颅内动脉闭塞患者的临床资料,术前建立急救流程与绿色通道,积极快速进行术前准备,术后做好血压的监测与管理、加强并发症的观察与护理、同时加强康复护理。结果2例取栓未成功,术中行DynaCT检查,明显再灌注出血,结束手术。其余34例取栓成功,造影显示血管再通,取栓术后3 d复查SWI提示再灌注微出血16例。出院后1～3个月随访mRs,显示0分11例、1分14例、2分5例、3分3例、5分1例、6分2例。结论T6SS配合做好Solitaire AB支架机械取栓术患者的护理,能最大程度为患者赢得手术时间,减少术后并发症,通过实施康复护理可减轻残障程度,帮助患者回归家庭和社会。     

支架取栓与静脉溶栓治疗急性大动脉闭塞型脑梗死的疗效对比

目的 探讨急性大动脉闭塞型脑梗死患者支架取栓治疗的疗效和安全性。方法 选取2016年4月至2019年4月在贺州市人民医院神经内科住院的急性大动脉闭塞型脑梗死患者65例,随机分为支架取栓治疗组及静脉溶栓治疗组,其中支架取栓治疗组35例,静脉溶栓治疗组30例,通过比较两组基线资料、血管再通率、治疗后24小时、14天的NIHSS评分改善情况、90天神经功能恢复评分(mRS)、治疗期间颅内出血转化、临床死亡率等,评估两组治疗方法的疗效及安全性。 结果 支架取栓组治疗后24小时、14天NIHSS评分较静脉溶栓组均有明显下降（均P＜0.05）,90天神经功能恢复良好率（mRS 0~2分）支架取栓治疗组（54.28%）明显高于静脉溶栓治疗组（24.33%）（P＜0.05）,支架取栓治疗组血管再通率（85.7%）显著高于静脉溶栓治疗组（16.67%）（P＜0.05）;两组间的总颅内出血转化风险及各亚型颅内出血转化风险比较差异无统计学意义（P＞0.05）。结论 支架取栓治疗急性大动脉闭塞型脑梗死效果较静脉溶栓更好。     

多模式桥接治疗急性缺血性卒中临床疗效及安全性

目的:评估多模式桥接治疗急性缺血性卒中(AIS)的疗效及安全性。方法:回顾性分析2015年1月到2016年8月广东省中山市人民医院神经内科收治的AIS患者100例的临床资料,根据病情选择适当的再通血管方式:对起病4.5 h小时内、有静脉溶栓指征者,立刻予静脉溶栓治疗,同时送介入室行全脑血管造影,了解病变血管情况,如血管已再通则结束手术;对前循环在6小时内、后循环在24小时内无静脉溶栓指征,且无全脑管造影禁忌症者,均予急诊行全脑血管造影术,了解病变血管情况,若血管已再通则结束手术;对血管仍有闭塞或狭窄,则考虑予动脉溶栓或支架成型术或支架取栓术等多模式桥接开通血管,评价治疗后NIHSS评分改善率,3个月后随mRS评分。结果:100例AIS患者接受多模式桥接治疗,平均年龄62.72±14.16岁,入院时平均NIHSS评分8.49±4.48分,发病到我院时间平均为3.59±2.37小时,所有患者均获得血管再通,术后残余狭窄程度(25.27±19.77)%;术后死亡3例,1例死于肺部严重感染,2例死于术后高灌注出血,余97例术后NIHSS评分3.63±4.3分,3个月后随访87例mRS2分,NIHSS 2.16±2.01分。结论:多模式联合治疗急性缺血性卒中能够有效地再通血管,可有效提高治疗效果,改善神经功能,促进患者恢复,值得临床推广应用。     

醒后卒中患者的临床诊断学特征及支架取栓技术的临床应用

目的探讨醒后卒中患者的临床诊断学特征及支架取栓治疗的安全性和可行性。 方法选取长治市人民医院神经内科2017年10月至2018年4月收治的3例醒后卒中患者支架取栓治疗的临床资料,分析患者的临床诊断学特征和支架取栓术后血管开通情况、并发症、神经功能改善情况,评估术后90 d时改良Rankin量表评分和Barthel指数评分情况。 结果3例醒后卒中患者均经磁共振血管成像(MRA)证实为颅内前循环大血管闭塞,2例为心源性脑梗死,1例为大动脉粥样硬化性脑梗死,发病时均有意识障碍,美国国立卫生研究院卒中量表评分为13～25分。支架取栓术中闭塞血管均成功再通,脑梗死溶栓血流分级评分≥2b级,术后复查头颅CT未发生颅内出血,梗死灶无扩大,术后30 d时美国国立卫生研究院卒中量表评分较入院时降低10～20分。术后90 d时改良Rankin量表评分1例为3分,2例为2分;Barthel指数评分1例为80分,2例为95分。 结论支架取栓治疗醒后卒中患者有较高的血管再通率,可显著改善患者的临床预后。     

觉醒型缺血性卒中进展后动脉内治疗1例并文献复习

目的 探讨多模式影像学选择的觉醒型缺血性卒中（WUS）患者进行静脉溶栓以及动脉内治疗的临床疗效。方法 解放军第306医院对1例WUS患者进行静脉溶栓桥接动脉取栓并急诊支架成形术治疗,随访90天,将临床资料进行总结与分析。结果 经过静脉溶栓后患者症状部分缓解,很快再次加重,随即进行动脉取栓并发现责任大脑中动脉重度狭窄,取栓后血流不能维持,给予急诊支架植入。病情演变过程复杂,最终结局良好,神经功能缺损改善。90天随访：患者痊愈,NIHSS 0分,mRS 0级。结论 对于WUS患者,通过多模式影像学选择后进行静脉溶栓以及动脉内治疗是安全有效的。     

Efficacy of Solitaire AB stent-release angioplasty in acute middle cerebral artery atherosclerosis obliterative cerebral infarction

BACKGROUNDIn both national and international studies, the safety and effectiveness of treatment with the Solitaire stent in patients with ischemic stroke caused by acute large vessel occlusion were good, and the disability rate was significantly reduced. However, there are currently only a few reports on the differences in endovascular treatment for different etiological classifications, especially in the anterior cranial circulation, aorta atherosclerotic stenosis, and acute thrombosis.AIMTo investigate the efficacy of Solitaire AB stent-release angioplasty in patients with acute middle cerebral artery atherosclerosis obliterative cerebral infarction.METHODSTwenty-five patients with acute middle cerebral atherosclerosis obliterative cerebral infarction were retrospectively enrolled in this study from January 2017 to December 2019. The Solitaire AB stent was used to improve anterior blood flow to maintain modified cerebral infarction thrombolysis [modified thrombolysis in cerebral infarction (mTICI)] at the 2b/3 level or above, the stent was then unfolded and released.RESULTSAll 25 patients underwent successful surgery, with an average recanalization time of 23 min. One patient died of cerebral hemorrhage and cerebral herniation after the operation. The National Institutes of Health Stroke Scale (NIHSS) scores immediately after surgery (7.5 ± 5.6), at 24 h (5.5 ± 5.6) and at 1 wk (3.6 ± 6.7) compared with the preoperative NIHSS score (15.9 ± 4.4), were significantly different (P < 0.01). One case of restenosis was observed 3 mo after surgery (the stenosis rate was 50% without clinical symptoms), the modified Rankin scale scores were 0 points in 14 cases (56%), 1 point in 4 cases (16%), 2 points in 2 cases (8%), 3 points in 3 cases (12%), 4 points in 1 case (4%), and 6 points in 1 case (4%).CONCLUSIONIn acute middle cerebral artery atherosclerosis obliterative cerebral infarction, when the Solitaire AB stent is unfolded and the forward blood flow is maintained at mTICI level 2b/3 or higher, stent release may be a safe and effective treatment method; however, long-term observation and a larger sample size are required to verify these findings.     

Application of retrievable Solitaire AB stents in the endovascular treatment of acute ischemic stroke

Purpose: Retrievable stents are widely used in acute ischemic stroke (AIS); however, the results remain unclear in Chinese patients. This study aimed to explore the usefulness of Solitaire AB stents in AIS.Materials and Methods: Seventy-three AIS patients treated with Solitaire AB stents for thrombectomy of large artery occlusion of anterior circulation in January 2014-June 2015 were retrospectively evaluated. Recanalization was assessed with the Thrombolysis In Cerebral Ischemia (TICI) scale. Clinical outcomes were assessed according to the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Operation-related complications were recorded. The main factors affecting successful recanalization with Solitaire AB were analyzed.Results: The 73 patients enrolled included 39 males and 34 females (median age of 59 [31-78] years); 77 Solitaire AB stents were used. The initial recanalization rate with Solitaire AB as the first thrombectomy method was 53.42% (39/73; recanalization group). Among the 34 patients with failed stent retrieval, 32 underwent other treatments; the final arterial recanalization rate was 89.04% (65/73). Perioperative embolization events and symptomatic intracranial hemorrhage (sICH) occurred in 5 and 8 patients, respectively. The mean NIHSS score was 9.12±3.86 one week after thrombectomy, significantly lower compared with admission values. In 31 patients (42.47%), NIHSS score decreased by >8. Good functional independence (mRS score≤2) was achieved in 39 patients (53.42%) at 90 days; 12 patients (16.44%) died. Compared with the recanalization group, the remaining patients showed lower AF and higher LAA percentages.Conclusion: Solitaire AB stents are useful in the endovascular treatment of AIS.     

Evaluation of using a double helical,closed-cell stent-retriever (Skyflow) for thrombectomy procedures in acute arterial occlusion: A preclinical study and a clinical trial

Background and purposeStent retriever thrombectomy is the standard therapeutic approach for ischemic stroke with acute large-vessel occlusion. This study evaluated the safety and efficacy of a new thrombectomy device (Skyflow) in the treatment of acute ischemic stroke.MethodsAfter an arterial occlusion model was established, stent-retriever thrombectomy was performed. Digital subtraction angiography (DSA) and autopsy were carried out immediately after thrombectomy in six animals in the acute experimental group. Simulated stent-retriever thrombectomy was performed for three animals in the subacute experimental group, and follow-up angiography and vascular pathological examination were assessed 90 days after the operation. In the clinical trial, 192 patients with intracranial anterior circulation large vessel occlusion, within 8 ?h of symptom onset, were included to undergo thrombectomy with either Skyflow or Solitaire FR stent retriever. Efficacy and safety endpoints were recorded (including successful reperfusion, favorable clinical outcomes, time from puncture to reperfusion, instrument operation success rates and National Institutes of Health Stroke Scale (NIHSS) scores at 7 days for efficacy endpoints, and symptomatic intracranial hemorrhage (sICH), subarachnoid hemorrhage (SAH) and all-cause mortality rates for safety endpoints).ResultsAll blood vessels achieved successful recanalization in the animal models. In the clinical trial, successful recanalization was attained in 88.4% of patients of the Skyflow group, which was comparable to that of the Solitaire FR group (82.5%) in the full analysis set of the clinical trial. There were no severe complications on DSA, an animal autopsy, or vessel pathological examination in animal experiments. Additionally, no statistically significant difference was observed between the Skyflow and Solitaire FR groups in the clinical trial regarding the safety endpoints.ConclusionThis study showed that the new Skyflow stent retriever is safe and effective for the treatment of acute large vessel occlusion, as demonstrated in our animal study and human trial.     

成人肝移植术后肝动脉并发症的介入治疗疗效分析

目的探讨肝移植(LT)术后肝动脉并发症血管内介入治疗的安全性和有效性。方法回顾性分析2010年1月~2015年2月我院12例肝移植术后经影像学证实的肝动脉并发症的临床资料。包括肝动脉血栓形成(HAT)5例,肝动脉狭窄(HAS)3例,HAS合并HAT 2例,肝动脉假性动脉瘤(HAP)合并HAS 2例,对肝动脉血栓形成、肝动脉狭窄程度超过50%及肝动脉假性动脉瘤形成者行介入治疗。结果成功治疗10例,技术包括导管内溶栓(CDT),经皮腔内血管成形术(PTA)及支架植入术(stent placement),技术成功率83%(10/12)。1例在PTA过程中破裂,成功植入覆膜支架,1例在溶栓过程中出现少量出血,经保守治疗后好转。术后两周血清丙氨酸氨基转氨酶(ALT)、天门冬氨酸氨基转氨酶(AST)、总胆红素(TBil)及直接胆红素(DBil)明显降低(P0.01)。随访2~24个月,2例因术后再狭窄和急性血栓形成再次介入治疗,余患者未出现介入相关并发症。结论血管内介入治疗可作为肝移植术后肝动脉并发症的一线治疗方法。     

Endovascular management in patients with acute basilar artery obstruction: low-dose intra-arterial urokinase and mechanical clot disruption

Mechanical clot disruption for the treatment of acute basilar artery occlusion (BAO) is known to provide a benefit. We aimed to determine the safety, recanalization rate and time-to-flow restoration of mechanical clot disruption and low dose urokinase (UK) infusions for the treatment of patients with acute BAO. Between June 2006 and June 2010, 21 patients with acute BAO underwent endovascular treatment that included angioplasty or stent placement. The time to treatment, duration of the procedure, dose of urokinase (UK), recanalization rates and symptomatic hemorrhages were analyzed. Clinical outcome measures were assessed at admission and at the time of discharge using the National Institutes of Health Stroke Scale (NIHSS) score and at three months after treatment using the modified Rankin Score (mRS). On admission, the median NIHSS score was 13.2. Median time from symptom onset to arrival at hospital was 356 minutes, and median time from symptom onset to intraarterial thrombolysis (IAT) was 49 minutes. We used the following interventional treatment regimens: Intra-arterial (IA) UK and a minimal mechanical procedure (n=14), IA UK with angioplasty (n=1), IA UK with angioplasty and stent placement (n=3) and IA UK with HyperForm (n=3). The recanalization (thrombolysis in cerebral ischemia grade II or III) rate was 90.5% (19/21). There was symptomatic hemorrhage in one patient (4.8%). The median NIHSS score at discharge was 6.3. The three-month outcome was favorable (mRS: 0-2) for 14 patients (66.7%) and poor (mRS: 3-6) for seven patients (33.3%). The overall mortality at three months was 14.3% (three patients died). Low-dose IAT with mechanical clot disruption is a safe and effective treatment for treatment for acute BAO.     

急性脑梗死机械取栓术后补救性支架置入16例临床效果分析

目的探讨急性脑梗死机械取栓术后补救性支架植入术的有效性与安全性。方法回顾性分析2014年10月至2018年12月解放军联勤保障部队第985医院急性脑梗死机械取栓术后前向血流不能维持,采取补救性支架置入的16例患者临床资料,分析其术前美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、术后血管再通程度[脑梗死溶栓(thrombolysis incerebral infarction,TICI)分级]、机械取栓次数、术后血管再闭塞率、颅内出血发生率、术后1周NIHSS评分、90 d临床良好预后[改良Rankin量表(modified Rankin scale,mRs)=0~2分]比率等指标。结果16例患者机械取栓后共补救性置入支架16枚(其中Solitaire支架15枚,阿波罗支架1枚),TICI=3级者12例,TICI=2b级者4例。平均取栓次数为(3.25±1.09)次。7例存在局限性狭窄,支架置入前进行球囊扩张。从发病到血管再通时间为(10.96±3.24)h。术后24 h复查计算机断层摄影血管造影术(computed tomography angiography,CTA),显示血管再闭塞者3例,颅内出血3例(均<10 ml)。去骨瓣减压术2例,术前NIHSS评分(24.25±4.58)分,术后1周(7.44±5.09)分。90 d良好预后(mRs≤2)10例,死亡1例(肺部感染)。结论急性脑梗死机械取栓后,存在重度狭窄或前向血流不能维持时,采取Solitaire支架或其他支架补救性置入,并发症较少,临床效果较好。     

SolitaireAB支架机械取栓治疗急性颅内动脉闭塞的围术期护理

目的总结SoLitaireAB支架机械取栓治疗急性颅内动脉闭塞的效果及护理要点。方法对53例急性颅内动脉闭塞患者采用SoLitaireAB支架机械取栓治疗,术前建立卒中急救绿色通道,术后严密观察病情,加强基础护理,做好血压及药物治疗的控制和管理,防止再灌注损伤等并发症的发生,早期进行康复训练。结果53例患者均取栓成功,44例闭塞血管均完全开通,9例血管未能完全开通,其中3例因为再通后仍存在管腔狭窄而放置支架。结论快速有效地完善术前准备,密切观察病情,尤其是意识和血压的变化,注意患者有无再灌注损伤,以及早期康复训练是SolitaireAB支架机械取栓治疗急性颅内动脉闭塞的护理重点。