补救性支架植入治疗急性缺血性脑卒中13例

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1、补救性支架植入治疗急性缺血性脑卒中13例周腾飞朱良付李天晓王子亮冯光薛绛宇白卫星李立郑州大学人民医院(河南省人民医院)河南省介入治疗中心摘要：目的探讨支架植入作为补救性措施治疗急性缺血性脑卒中的有效性与安全性。方法回顾性分析13例大脑前循环大血管闭塞发病8h内并接受补救性支架植入治疗的急性缺血性脑卒中患者临床资料。所有患者治疗前均经其它再通术式(静脉溶栓、动脉溶栓、Penumbra装置吸栓、Solitaire支架取栓)未果。根据脑梗死溶栓(TICI)治疗后血流分级评价血管再通，记录围手术期出血及梗死并发症

2、。根据美国国立卫生研究院卒中量表(NTHSS)评分评价术后1周神经功能改善情况。根据改良Rankin量表(mRS)评分评价术后3个月预后指标。结果13例接受补救性治疗患者共植入支架16枚，支架植入前采用Solitaire可回收支架取栓10例，Penumbra装置吸栓3例，经静脉尿激酶溶栓1例，经动脉尿激酶溶栓1例。12例(92.3%)患者闭塞血管部分或全部再通(TICIM2B/3)。NIHSS评分由术前平均(16.15±5.81)分改善为术后1周平均(8.08±5.61)分，差异有统计学意义(P<0.05

3、)o术后3个月，7例(53.8%)预后良好(mRSW2),2例死亡。术后发生颅内出血2例，手术相关栓塞3例。结论颅内支架植入术作为不同组合药物溶栓治疗急性缺血性脑卒中患者血管再通的补救性措施，安全有效。关键词：急性脑梗死;可回收支架;机械取栓;支架植入;补救性治疗;作者简介：李天晓E-mail:dr.litianxiao@vip.163.com收稿日期:2016-08-05Rescuestentimplantationforthetreatmentofacuteischemicstroke:initial

4、experiencein13patientsZHOUTengfeiZHULiangfuLITianxiaoWANGZiliangFENGGuangXUEJiangyuBAIWeixingLILiPeople'sHospitalofZhengzhouUniversity,HenanProvincialPeople'sHospital,HenanProvincialInterventionalTherapyCenter;Abstract：ObjectiveToevaluatethesafetyandeffic

5、acyofstentimplantationusedasarescuemeasureforacuteischemicstroke.MethodsTheclinicaldataof13patientswithacuteischemicstrokecausedbylargearteryocclusionofanteriorcerebralcirculationthatoccurredwithin8hoursbeforeclinicalvisit,whohadreceivedrescuestentimplemt

6、dtionatauthors，hospital,wereretrespectivelyanalyzed.Beforestentinip1antation,allpatienlsfailedtorespondtootherrecanalizationtreatments,includingintravenousthrombolysis,intra-arterialthrombolysis,mechanicalthrombectomywithPenumbradevice,andSolitaircstentth

7、rombectomy.Angiographywasperformedimmediatelyafterstentimplantation.Vascularrecanalizationconditionwasevaluatedwithbloodflowgradingthatwasbasedonthrombolysisincerebralinfarction(TICI)criterion.Perioperativebleedingandcomplicationswererecorded.NationalInst

8、itutesofHealthStrokeScale(NIHSS)scorewasusedtoassesstheimprovementofneurologicalfunctionatoneweekafteroperation.ModifiedRankinscale(mRS)scorewasusedtoevaluatetheprognosisat3monthsafteroperation.ResulIsAtotalof16sten