目的：评价血管内治疗对急性椎基底动脉闭塞(acute vertebrobasilar artery occlusion,AVBAO)致急性缺血性脑卒中(acute ischemic stroke,AIS)患者的安全性及有效性.方法：回顾分析暨南大学附属第一医院2011年至2015年间,实施血管内治疗的13例AVBAO致急性缺血性脑卒中患者的临床及影像学资料.应用脑梗死溶栓等级系统(TICI)分级评定颅内血管再通情况.临床随访3个月后采用改良Rankin量表评分(mRS),评估患者预后情况.结果：13例患者的年龄平均数为62.5岁(男性11例),平均的发病到穿刺的时间为(539.0±267.7)min,入院时的NIHSS评分中位数为21.1(6~30),GCS评分中位数为8.6分(4~14).11例患者闭塞血管成功再通(TICI≥2b),血管成功再通率为84.6%.术后症状性颅内出血1例.3个月后临床随访,38.5%(5/13)的患者预后中等或良好(mRS≤3).其中,以支架取栓为初始治疗的患者,42.85%的患者预后良好.以动脉溶栓为初始治疗手段的患者,16.7%的患者预后良好.3个月后整体死亡率为53.8%(7/13).结论：血管内治疗可使急性椎基底动脉闭塞获得较高的再通率,支架取栓在改善预后方面或许优于动脉溶栓.
Abstract
Aim: The safety and efficacy of the endovascular recanalisation therapy (ERT) for a-cute ischemic stroke caused by proximal intracerebral occlusion of the anterior circulation has been proved. Due to the high mortality and disability of Acute VBAO, more attention has been attached to endovascular recanalisation therapy. However, the effectiveness of ERT for Acute completely VBAO was not well demonstrated. Methods: The clinical and angiographic data of 13 patients who received ERT for acute posterior circulation ischemic stroke caused by acute completely VBAO in our endovascular database from 2011 to 2015 were retrospectively analyzed.Successful recanalisation was defined as Thrombolysis in Cerebral Infarction (TICI) grade ≥2b. The modified Rankin scale (mRS) score was used to measure outcome. Results: 13 patients with a mean age of 62.5 years were included in the study (11 men and 2 women). The mean time from symptom onset to treatment was (539.0±267.7) min. The National Institutes of Health Stroke Scale (NIHSS) and GlasgowComa Scale (GCS) score on admission were 21.1 (range 6-30) and 8.6 (range 4-14), respectively. Recanalization (TICI ≥2b) was successful in 11 of our 13 patients (84.6%), with the TICI grade of 3 in six patients and 2b in five patients. One patient (7.7%) suffered a symptomatic intracerebral hemorrhage. At 3 months, 38.5% (5/13) overall had good and moderate outcome (mRS ≤3); 42.8.5% of patients treated with an Solitaire stent retrievers procedure as the initial ERT and 16.7% of patients treated with IAT as the initial ERT had good outcome (mRS ≤2). The overall mortality rate was 53.8% (7 of 13) at 3 months. Conclusions: ERT may be effective and safe for acute completely vertebrobasilar artery occlusion (VBAO) in acute posterior circulation ischemic stroke patients; the Solitaire stent retrievers procedure (compared to intra-arterial thrombolysis, IAT) may have greater efficacy and safety.
关键词
急性椎-基底动脉闭塞 /
卒中 /
血管内治疗 /
再通
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Key words
acute vertebrobasilar occlusion /
posterior circulation ischemic stroke /
endovascular treatment /
recanalization
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参考文献
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