颈动脉支架置入术在急性前循环串联闭塞卒中机械取栓治疗中的有效性和安全性分析

张东焕; 刘义锋; 康梅娟; 汪宁; 孙军; 温昌明

doi:10.16766/j.cnki.issn.1674-4152.002543

颈动脉支架置入术在急性前循环串联闭塞卒中机械取栓治疗中的有效性和安全性分析

doi: 10.16766/j.cnki.issn.1674-4152.002543

南阳市中心医院神经内科，河南南阳 473000

基金项目:

河南省医学科技重点攻关项目 202102310079

河南省医学科技重点攻关项目 192102310349

详细信息

通讯作者:
温昌明, E-mail: 13838729696@sina.com

中图分类号: R543.4
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出版历程
- 收稿日期: 2021-01-14
- 网络出版日期: 2022-09-23

Analysis of safety and efficacy of emergent carotid artery stenting in patients with acute anterior circulation stroke with tandem lesion treated with mechanical thrombectomy

Department of Neurology, Nanyang City Central Hospital, Nanyang, Henan 473000, China

摘要

摘要: 目的探讨急性前循环串联闭塞卒中患者行机械取栓治疗中颅外颈动脉病变的治疗方案，评估其有效性和安全性。方法回顾性分析2018年1月—2019年12月南阳市中心医院收治的18例行血管内治疗的颈内动脉颅外段伴同侧颅内动脉急性串联闭塞患者的临床资料。其中男性9例，女性9例，年龄为60~70岁。根据治疗方式的不同，将18例患者分为急诊支架组(11例)和急诊非支架组(7例)。术中即刻血管再通情况根据脑梗死溶栓(TICI)分级判断，将卒中发生90 d改良Rankin量表(mRS)评分0~2分定义为临床预后良好。结果 2组患者年龄、性别、术前美国国立卫生研究院卒中量表(NIHSS)评分、术前Alberta卒中项目早期CT(ASPECT)评分、病因分型、治疗方式、病变类型、血管闭塞部位等临床基线资料比较，差异均无统计学意义(均P＞0.05)；急诊支架组和急诊非支架组的术后血管成功再通率(TICI分级为2b~3级)分别为72.7%和71.4%，组间差异无统计学意义(P＞0.05)；2组术后症状性颅内出血率分别为9.1%和0，组间差异无统计学意义(P＞0.05)；2组患者术后90 d改良mRS评分及90 d病死率比较差异无统计学意义(均P＞0.05)；2组患者术后残余狭窄率差异有统计学意义(P＜0.05)。结论在急性前循环串联闭塞的血管内治疗中，急诊颈动脉颅外段支架置入术可能是有效和安全的。
- 急诊颈动脉支架 /
- 串联闭塞 /
- 机械取栓 /
- 预后
Abstract: Objective To explore the treatment options of mechanical thrombectomy for extracranial carotid artery lesions in patients with acute anterior circulation tandem occlusion stroke, and to evaluate its efficacy and safety. Methods From January 2018 to December 2019, 18 patients with acute tandem occlusion of the extracranial internal carotid artery and intracranial large artery were admitted to Department of Neurology, Nanyang City Central Hospital and treated by endovascular treatment. There were 9 males and 9 females, aged 60 to 70 years old. According to different treatment methods, 18 patients were divided into emergency stent group (11 cases) and emergency non-stent group (7 cases). The immediate intraoperative recanalization of blood vessels during the operation was judged according to the classification of cerebral infarction thrombolysis (mTICI), and the 90-day modified Rankin Scale (mRS) score of 0-2 was defined as a good clinical prognosis. Results There was no statistically significant difference in clinical baseline data such as age, gender distribution, preoperative National Institutes of Health Stroke Scale (NIHSS) score, preoperative Alberta stroke project early CT (ASPECT) score, etiology classification, treatment method, lesion type, blood vessel occlusion site in two groups (all P > 0.05). The rates of successful recanalization of blood vessels (mTICI class 2b-3) of the emergency stent group and emergency non-stent group was 72.7% and 71.4%, respectively; however, there was no statistically significant difference (P > 0.05). The rates of symptomatic intracranial hemorrhage were 9.1% and 0, respectively. Also, there was no statistically significant difference (P > 0.05). There was no statistically significant difference in the modified mRS score and 90-day mortality between the two groups of patients after 90 days (all P > 0.05). The difference in the residual stenosis rate between the two groups was statistically significant (P < 0.05). Conclusion In the endovascular treatment of acute anterior circulation tandem occlusion, emergency extracranial carotid artery stenting may be effective and safe.
- Emergent carotid artery stenting /
- Tandem occlusion /
- Mechanical thrombectomy /
- Prognosis

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图 1 急诊支架置入取栓组典型病例DSA影像

注：A为右侧颈内动脉起始段闭塞；B为保护伞下右侧颈内动脉起始段球囊扩张术；C为球囊扩张术后急诊支架植入治疗；D为右侧大脑中动脉血栓；E为支架植入取栓后成功再通；F为急诊支架植入取栓后右侧颈内动脉及大脑中动脉血流恢复。

Figure 1. DSA images of typical cases in emergency stent group

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图 2 急诊非支架置入取栓组典型病例DSA影像

注：A为右侧颈内动脉起始段闭塞；B为保护伞下右侧颈内动脉起始段球囊扩张术；C为球囊扩张术后残余狭窄约40%；D为右侧颈内动脉末端闭塞；E为支架植入取栓后成功再通；F为右侧颈内动脉起始段血流稳定，再急诊支架植入治疗。

Figure 2. DSA images of typical cases in emergency non-stent group

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表 1 2组急性前循环串联闭塞卒中患者临床基线资料比较

Table 1. Comparison of clinical baseline data of acute ischemic stroke patients with acute anterior circulation tandem occlusion in two groups

项目	急诊支架组(n=11)	急诊非支架组(n=7)	统计量	P值
性别(男/女，例)	6/5	3/4	0.221^a	0.638
年龄[M(P₂₅, P₇₅)，岁]	64(60, 67)	66(61, 70)	-0.917^b	0.359
术前NIHSS(x±s，分)	16.7±7.8	18.9±7.1	-0.582^c	0.569
术前ASPECT(x±s，分)	8.1±0.5	8.0±0.8	0.286^c	0.778
术前静脉溶栓[例(%)]	3(27.3)	4(57.1)	1.517^a	0.218
危险因素[例(%)]
高血压	7(63.6)	5(71.4)	0.110^a	0.740
糖尿病	5(45.5)	2(28.6)	0.485^a	0.486
血脂异常	6(54.5)	3(42.9)	0.221^a	0.638
房颤	1(9.1)	1(14.3)	0.110^a	0.740
吸烟史	6(54.5)	1(14.3)	2.755^a	0.097
颈动脉病变类型[例(%)]			0.072^a	0.789
闭塞	7(63.6)	4(57.1)
重度狭窄	4(36.4)	3(42.9)
时间
发病-入院(x±s，min)	147.5±27.6	125.4±12.0	1.977^c	0.065
入院-穿刺(x±s，min)	76.0±32.0	90.0±31.0	-0.905^c	0.379
穿刺-再通 [M(P₂₅, P₇₅)，min]	115.1(99.3, 130.9)	114.0(98.6, 129.4)	-0.182^b	0.860
发病-再通 [M(P₂₅, P₇₅)，min]	223.5(197.6, 249.3)	215.3(190.4, 240.2)	-0.317^b	0.791
颅内闭塞位置[例(%)]			0.763^a	0.382
C7	0	1(14.3)
A1	1(9.1)	1(14.3)
M1	9(81.8)	4(57.1)
M2	1(9.1)	1(14.3)
颅内病变治疗方法[例(%)]			0.613^a	0.434
支架取栓	10(90.9)	6(85.7)
抽吸	1(9.1)	0
动脉溶栓	0	1(14.3)
注：^a为χ²值，^b为Z值，^c为t值。

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表 2 2组急性前循环串联闭塞卒中患者预后和安全性指标比较[例(%)]

Table 2. Comparison of prognosis and safety indexes of acute ischemic stroke patients with acute anterior circulation tandem occlusion in groups[cases (%)]

组别	例数	mTICI分级		90 d mRS评分(分)		90 d死亡	颅内出血		术后残余颈动脉狭窄(≥70%)
组别	例数	0~2a级	2b~3级	0~2	3~6	90 d死亡	症状性出血	非症状性出血	术后残余颈动脉狭窄(≥70%)
急诊支架组	11	3(27.3)	8(72.7)	7(63.6)	4(36.4)	2(18.2)	1(9.1)	0	1(9.1)
急诊非支架组	7	2(28.6)	5(71.4)	4(57.1)	3(42.9)	2(28.6)	0	0	4(57.1)
P值		0.999^a		0.999^a		0.999^a	0.999^a		0.047^a
注：^a为使用Fisher精确检验。

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