CAJ | 학술논문

目的评价前循环急性多发闭塞(AMO)病变血管内治疗的安全性及有效性.方法回顾性分析血管内治疗10例AMO病变患者的临床资料.先对颈内动脉近端病变行球囊扩张并将导引导管置于理想位置,以动脉溶栓和(或)取栓开通颅内血管后对颅外近端病变血管行支架植入.依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个月后对患者进行改良Rankin量表评分(mRS),评估预后情况.入院及出院时美国国立卫生研究院卒中量表(NIHSS)评分比较采用配对样本t检验进行比较.结果所有患者近端颈内动脉病变均成功行球囊扩张,并置入指引导管至理想位置.9例颅内病变血管成功再通(TICI≥2b),并对8例近端颈内动脉成功行支架植入,1例颈内动脉栓塞,栓子较大无法取出,未植入支架,但椎动脉造影示后交通动脉代偿可,结束手术.1例颅内病变未能再通,未再对近端颅外病变血管进一步处理.术后3例出现围手术期并发症,其中无症状少量蛛网膜下腔出血1例,症状性颅内出血2例(1例死亡).3个月后临床随访结局良好者5例、中等2例、差2例.患者入院时NIHSS评分平均(15.7±2.2)分,出院平均(9.6±4.7)分,2者差异有统计学意义(t=2.86,P=0.02).结论血管内重建治疗AMO病变技术可行,相对安全、有效.
목적 평개전순배급성다발폐새(AMO)병변혈관내치료적안전성급유효성.방법 회고성분석혈관내치료10례AMO병변환자적림상자료.선대경내동맥근단병변행구낭확장병장도인도관치우이상위치,이동맥용전화(혹)취전개통로내혈관후대로외근단병변혈관행지가식입.의뇌경사용전등급계통(TICI)분급평정로내혈관재통정황.림상수방3개월후대환자진행개량Rankin량표평분(mRS),평고예후정황.입원급출원시미국국립위생연구원졸중량표(NIHSS)평분비교채용배대양본t검험진행비교.결과 소유환자근단경내동맥병변균성공행구낭확장,병치입지인도관지이상위치.9례로내병변혈관성공재통(TICI≥2b),병대8례근단경내동맥성공행지가식입,1례경내동맥전새,전자교대무법취출,미식입지가,단추동맥조영시후교통동맥대상가,결속수술.1례로내병변미능재통,미재대근단로외병변혈관진일보처리.술후3례출현위수술기병발증,기중무증상소량주망막하강출혈1례,증상성로내출혈2례(1례사망).3개월후림상수방결국량호자5례、중등2례、차2례.환자입원시NIHSS평분평균(15.7±2.2)분,출원평균(9.6±4.7)분,2자차이유통계학의의(t=2.86,P=0.02).결론 혈관내중건치료AMO병변기술가행,상대안전、유효.
Objective To evaluate the safety and efficacy of the endovascular treatment of anterior circulation multiple occlusions (AMO) in acute ischemic stroke.Methods The clinical data of 10 patients with AMO treated by endovascular method from January 2011 to August 2013 were retrospectively analyzed.The proximal internal carotid artery (ICA) occlusion was treated using angioplasty in order to achieve ideal location of the guiding catheter.When necessary,stenting was performed after the reconstitution of the intracranial vessel.Recanalization was assessed according to the thrombolysis in cerebral ischemia (TICI) grade.Clinical prognosis was assessed using mRS at 3 months.The National Institutes of Health Stroke Scale (NIHSS) on admission and at discharge was compared using t test.Results The intracranial vessel was recanalized successfully (TICI ≥ 2b) in 9 cases and cervical carotid was stented in 8 cases.Adverse events were recorded in 3 patients,including one case of asymptomatic subarachnoid hemorrhage and two cases of symptomatic intra-cerebral hemorrhage.Mortality rate was 10 ％ (n=1).At the three-month follow up,mRS ≤ 2 was observed in five patients.The mean NIHSS scores was 15.7±2.2 on admission and 9.6±4.7at discharge,and the difference was statistic significant(t=2.86,P=0.02).Conclusion Endovascular therapy of AMO is technically feasible,and relatively safe and effective.