目的 探讨大脑中动脉急性闭塞后行血管内机械取栓的优化治疗方式及疗效.方法 以行血管内机械取栓的大脑中动脉闭塞的急性缺血性卒中患者为研究对象,回顾性分析其责任病灶特点、血管内治疗方式、血管开通状况及术后神经功能改善状况.结果 连续纳入2014年1月-2016年8月期间于中山市人民医院脑血管介入科行急性大脑中动脉闭塞机械取栓的患者77例,其中M1段闭塞52例(右侧27例,左侧25例),上干闭塞15例,下干闭塞10例.取栓后Solitaire支架释放在狭窄部位17例,合并大脑中动脉严重狭窄应用Gateway球囊扩张6例,局部动脉给予溶栓药物3例.经血管内治疗后,77例大脑中动脉闭塞全部成功开通.术后再灌注出血6例(7.79%),取栓术后因急性脑肿胀行去骨瓣减压术5例(6.49%),术后90 d患者预后良好[改良Rankin量表(modified Rankin Scale,mRS)评分<2分]48例(62.34%).结论 大脑中动脉急性闭塞行Solitaire支架急诊取栓可获得满意的再通率及3个月良好预后.%Objective To explore optimization of treatment method of intra-arterial thrombectomy and its clinical effects in acute middle cerebral artery occlusion. Methods Patients with acute middle cerebral artery (MCA) occlusion who underwent thrombectomy by using Solitaire stent were taken as study subjects. The involved lesions characteristics, endovascular treatment methods, recanalization status and post-surgery improvement of neurological function were analyzed retrospectively. Results A total of 77 patients with acute middle cerebral artery (MCA) occlusion who underwent thrombectomy by using Solitaire stent in Dept. of Cerebral Vascular Intervention, Zhongshan People's Hospital during Jan. 2014 and August, 2016 were enrolled into study consecutively. The occluded arteries included M1 segment of MCA (M1-MCA, Right n=27, Left n=25), inferior division of MCA (MCA-ID, n=10), and superior division of MCA (MCA-SD, n=15). Residual luminal stenosis after thrombectomy was found in 26 cases, among which stent implantation (n=17), balloon dilatation (n=6) or regional thrombolysis (n=3) were carried out ultimately. Successful recanalization was achieved in all patients (n=77), in which 48 patients showed good clinical outcome (62.34% ) at 90 d after surgery with modified Rankin Scale (mRS) score <2. Postoperative intracranial hemorrhage occurred in 6 patients (7.79%), and decompressive craniectomy were carried out in 5 patients (6.49%) with acute cerebral swelling . Conclusion This study suggests that thrombectomy by using Solitaire stent can achieve satisfactory recanalization rate in patients with MCA occlusion and good prognosis at month 3.
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