天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (10): 1053-1057.doi: 10.11958/20170293

• 临床研究 • 上一篇    下一篇

Solitaire 支架动脉取栓术联合多模式血管再通术治疗 急性脑梗死疗效观察

傅懋林，戴为正，张永刚，肖雪玲△，王双虎，何文钦   

  1. 福建省泉州市，解放军第 180 医院神经内科（邮编 362000）
  • 收稿日期:2017-03-08 修回日期:2017-07-06 出版日期:2017-10-15 发布日期:2017-10-13
  • 通讯作者: 傅懋林 E-mail:22903263@qq.com
  • 作者简介:傅懋林（1983），男，主治医师，硕士，主要从事脑血管病研究

The clinical observation on the treatment of acute cerebral infarction by combining Solitaire stent arterial embolectomy with multi-mode vascular recanalization

FU Mao-lin, DAI Wei-zheng, ZHANG Yong-gang, XIAO Xue-ling△, WANG Shuang-hu, HE Wen-qin   

  1. Department of Neurology, the 180th Hospital of PLA, Quanzhou, Fujian 362000, China
  • Received:2017-03-08 Revised:2017-07-06 Published:2017-10-15 Online:2017-10-13

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摘要： 目的 探讨 Solitaire 支架动脉取栓术联合多模式血管再通术治疗急性脑梗死的有效性及安全性。方法 收集 2014 年 11 月—2017 年 2 月我院采用动脉取栓术联合多模式血管再通技术治疗急性脑梗死患者 22 例（研究 组），其中动脉取栓后联合球囊扩张术 16 例，支架置入术 4 例（Solitair 支架 3 例，Apollo 支架 1 例），动脉溶栓术 2 例。另择我科 2011 年 10 月—2014 年 10 月单纯采用 Solitaire 支架动脉取栓治疗的颅内大血管闭塞急性脑梗死患 者 18 例作为对照组。比较 2 组发病时间至置鞘时间，发病至血管再通时间，血管内介入治疗术的血管再通情况，入 院及出院时 NIHSS 评分及 90 d 时 mRS 评分，并发症及死亡的发生情况。结果 2 组发病时间至置鞘时间及发病至 血管再通时间差异均无统计学意义。研究组血管再通情况明显优于对照组（P＜0.05）。2 组入出院时 NIHSS 评分变 化值差异无统计学意义，近期疗效相近。而研究组 90 d 后 mRS 评分明显低于对照组（P＜0.05）。2 组患者症状性颅 内出血、高灌注脑病、操作相关并发症的发生率及死亡率差异无统计学意义。结论 Solitaire 支架动脉取栓术联合 多模式血管再通术治疗急性脑梗死，可提高患者的血管再通率，改善患者远期临床预后，提高患者生存质量，且不增 加并发症发生率及死亡率，安全有效。

关键词: 脑梗死, 动脉取栓术, 多模式血管再通术, 心源性脑栓塞, 血管再通率, 临床预后, 安全性

Abstract: Objective To explore the efficacy and safety of Solitaire stents and the multi-mode vascular recanalization in the treatment of acute cerebral infarction. Methods Twenty- two patients with acute cerebral infarction, who were treated by Solitaire stents and the multi-mode vascular recanalization (research group) in our hospital from November 2014 to February 2017, were included in this study. Among them, 16 cases were combined with balloon dilation after arterial thrombosis, 4 cases were given stent implantation (3 cases were given Solitair stent and 1 case was given Apollo stent), and 2 cases were given arterial catheter directed thrombolysis. Eighteen patients with acute cerebral infarction who were treated only by Solitaire stent artery occlusion from October 2011 to October 2014 were used as control group. Data of the onset to the vagina vasorum time, the onset to the recanalization time, the revascularization of interventional therapy, the NIHSS scores at admission and discharge, mRS score after 90- day treatment, incidence rate and the mortality were compared between two groups. Results There were no significant differences in the durations from onset to the vagina vasorum and from the onset to the recanalization between the two groups. The recanalization was better in research group than that of control group (P＜0.05). There were no significant differences in scores of NIHSS at hospital discharge and admission between two groups. The near-term treatment efficacy was similar in two groups. However, mRS score was significantly lower in the research group than that in control group after 90-day treatment (P < 0.05). There were no significant differences in the symptomatic intracranial hemorrhage, high perfusion encephalopathy, the incidence rate and the mortality rate of the complications related to the operation between two groups of patients. Conclusion Solitaire stents and the multi-mode vascular recanalization can significantly improve the revascularization, the further clinical prognosis and the quality of survival in patients with acute cerebral infarction, which are safe and efficacy without increasing incidence rate and mortality rate of complications.

Key words: brain infarction, arterial thrombolectomy, multimode vascularization, cardiogenic cerebral embolism, revascularization rate, clinical prognosis, security