CAJ | 학술논문

目的探讨Solitaire-AB型支架用于急性脑基底动脉闭塞动脉内取栓的疗效及安全性.方法回顾性分析9例采用Solitaire-AB型支架行急性基底动脉闭塞取栓术患者的临床资料,对适合取栓治疗的基底动脉闭塞患者,均采用So]itaire-AB型支架进行取栓术.对取栓治疗再通后残余重度狭窄者同时行支架成形术.分析患者即时取栓效果,术后并发症情况,比较患者治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、mRs评分及预后情况.患者出院后6个月进行随访,复查mRs评分及NIHSS评分,并进行DSA或MRA评估.不同时间NIHSS评分的比较采用t检验.结果 9例患者基底动脉术中即刻均获再通;其中6例再通后术中造影显示残余重度狭窄,实施球囊扩张及支架成形术.1例患者术后1d基底动脉再次闭塞,造影证实后使用微导介入溶栓,基底动脉开通,但患者临床症状未见明显改善,6d后因呼吸循环衰竭死亡.无术中出血事件发生.患者入院时NIHSS评分平均(16.0±3.8)分、出院平均(2.4±1.2)分、术后6个月(1.6±0.8)分,出院时及出院后6个月与人院时相比差异均有统计学意义(t值分别为7.52、9.76,P值均＜0.01);mRs评分入院时0分2例、1分4例、2分1例、3分l例,出院后6个月0分4例、1分2例、2分1例,出院时与入院相比差异有统计学意义(P＜0.01).1例患者在随访第4个月突发昏迷,MRA证实基底动脉闭塞,由于发病时间已超过36 h,且MRI提示脑干、小脑半球大面积梗死,未再行介入干预,保守治疗期间死亡;其余患者出院后6个月的MRA或DSA造影评估未见基底动脉明显狭窄.结论对急性基底动脉栓塞的患者,使用Solitaire-AB型支架取栓术是相对安全、有效的.
목적 탐토Solitaire-AB형지가용우급성뇌기저동맥폐새동맥내취전적료효급안전성.방법 회고성분석9례채용Solitaire-AB형지가행급성기저동맥폐새취전술환자적림상자료,대괄합취전치료적기저동맥폐새환자,균채용So]itaire-AB형지가진행취전술.대취전치료재통후잔여중도협착자동시행지가성형술.분석환자즉시취전효과,술후병발증정황,비교환자치료전후미국국립위생연구원졸중량표(NIHSS)평분、mRs평분급예후정황.환자출원후6개월진행수방,복사mRs평분급NIHSS평분,병진행DSA혹MRA평고.불동시간NIHSS평분적비교채용t검험.결과 9례환자기저동맥술중즉각균획재통;기중6례재통후술중조영현시잔여중도협착,실시구낭확장급지가성형술.1례환자술후1d기저동맥재차폐새,조영증실후사용미도개입용전,기저동맥개통,단환자림상증상미견명현개선,6d후인호흡순배쇠갈사망.무술중출혈사건발생.환자입원시NIHSS평분평균(16.0±3.8)분、출원평균(2.4±1.2)분、술후6개월(1.6±0.8)분,출원시급출원후6개월여인원시상비차이균유통계학의의(t치분별위7.52、9.76,P치균＜0.01);mRs평분입원시0분2례、1분4례、2분1례、3분l례,출원후6개월0분4례、1분2례、2분1례,출원시여입원상비차이유통계학의의(P＜0.01).1례환자재수방제4개월돌발혼미,MRA증실기저동맥폐새,유우발병시간이초과36 h,차MRI제시뇌간、소뇌반구대면적경사,미재행개입간예,보수치료기간사망;기여환자출원후6개월적MRA혹DSA조영평고미견기저동맥명현협착.결론 대급성기저동맥전새적환자,사용Solitaire-AB형지가취전술시상대안전、유효적.
Objective To explore and evaluate the efficacy and safety of mechanical thrombectomy with the Solitaire AB Revascularization Device in acute basilar artery occlusion.Methods Nine patients with basilar artery occlusion were treated with direct thrombectomy by using Solitaire AB stent retrievers between August 2010 and October 2012.Stent angioplasty was performed for patients with serious residual stenosis.Neurologic status was evaluated before and after treatment according to the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scales (mRs).Neurologic status was evaluated after treatment according to the NIHSS and mRs 6 months after stent placement.Stent patency at follow-up was assessed by MR angiography,or DSA 6 months after stent placement.Results Successful revascularization was achieved in all patients.Stenting and angioplasty were performed in 6 patients with serious residual stenosis.The complication of cerebral hemorrhage did not occur in any patient.Acute thrombosis happened in one patient one day after procedure.Emergent angiography showed re-occlusion of basilar artery.Intraarterial thrombolytic therapy was given,and reperfusion was achieved,but the patient died 6 days later.One patient developed coma at 4th month of follow-up.MRA showed acute basilar artery occlusion again and magnetic resonance imaging showed extensive ischemic damage of the brainstem.The patient died during the conservative treatment period.The mean NIHSS scores were 2.4 ± 1.2 at discharge.The mRs scores were 0 in 2 patients,1 in 4 patients,2 in one patient,and 3 in 1 patient at discharge.Conclusion Mechanical thrombectomy with the Solitaire AB stent in acute basilar artery occlusion is relatively safe and effective.