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。

Clinical analysis of 16 cases of remedial stent placement after mechanical thrombectomy for acute cerebral infarction

Objective To explore the efficacy and safety of the remedial stent implantation after mechanical thrombectomy for acute cerebral infarction.Methods From October 2014 to December 2018,the clinical data of 16 patients with acute cerebral infarction who could not maintain forward blood flow after mechanical thrombectomy in 985 Hospital of joint service support force of PLA were analyzed retrospectively.To analyze the score of National Institutes of Health Stroke Scale(NIHSS),degree of vascular recanalization after operation thrombolysis incerebral infarction(TICI)classificatio,mechanical thrombolytic number,postoperative vascular reocclusion rate,incidence of intracranial hemorrhage,NIHSS score 1 week later,good clinical result after 90 days(improved Rankin scale,mRs=0-2)and other indicators.Results After mechanical embolectomy,16 stents were implanted(15 of them were Solitaire stents,1 of them was Apollo stents),12 patients with TICI=3,and 4 patients with TICI=2b.The average number of times of mechanical thrombectomy was(3.25±1.09).Balloon expansion was performed before stent placement in 7 patients with limited stenosis.The time from the onset to the reperfusion was(10.96±3.24)hours.Computed tomography angiography(CTA)was reexamined 24 hours after operation,showing vascular of 3 cases were reocclusion and 3 cases occured intracranial hemorrhage(all less than 10 ml).In 2 cases of decompressive osteotomy,NIHSS score was improved from preoperative(24.25±4.58)points to postoperative(7.44±5.09)points.After 90 days,10 patients had a good prognosis(mRs≤2)and 1 patient died(pulmonary infection).Conclusion After mechanical thrombectomy of acute cerebral infarction,if there is severe stenosis or forward blood flow can not be maintained,use the Solitaire stent or other stent to remedy the placement,with fewer complications and better clinical effect.