急性基底动脉闭塞患者血管内支架机械取栓治疗的临床效果研究

摘要

目的 探讨急性基底动脉闭塞(ABAO)患者使用Solitaire AB型支架血管内机械取栓治疗的临床疗效和安全性,并分析影响临床预后的因素.方法 回顾性分析2015年3月—2017年12月于河北医科大学第二医院神经内科住院治疗的16例ABAO患者资料.其均使用Solitaire AB型支架系统进行血管内机械取栓治疗,分析血管内机械取栓治疗的血管再通率及并发症,评估治疗90 d临床预后,分析影响临床预后的因素.结果 16例患者中14例(14/16)顺利完成血管内机械取栓治疗.11例(11/16)患者的闭塞血管成功再通〔改良的脑缺血治疗分级(mTICI)3级或2b级〕.术中未发生症状性颅内出血事件,1例(1/16)取栓支架回收失败,1例(1/16)发生医源性夹层.术后90 d内随访共5例(5/16)患者死亡.存活患者改良Rankin量表(mRS)评分为(2.0±1.4)分.7例(7/16)患者预后良好(mRS评分≤2分),9例(9/16)患者预后不良(mRS评分>2分或死亡).预后良好与预后不良患者性别、术前美国国立卫生研究院卒中量表(NIHSS)评分、术前颅脑CT后循环急性卒中预后早期评分(pc-ASPECTS)、就诊时昏迷发生率、就诊时偏瘫发生率、发病至入院时间、发病至血管再通时间比较,差异均有统计学意义(P<0.05).结论 使用Solitaire AB型支架进行的血管内机械取栓治疗ABAO患者,有较高的血管再通率,可改善临床预后.%Objective To investigate the clinical efficacy and safety of endovascular mechanical thrombectomy(EMT) with Solitaire AB stent in patients with acute basilar artery occlusion(ABAO),and to analyze the factors that affect the clinical prognosis.Methods In this retrospective study,we enrolled 16 consecutive cases of ABAO from Department of Neurology,the Second Hospital of Hebei Medical University from March 2015 to December 2017.All of them underwent EMT with the Solitaire AB stent.The recanalization rate and complications of EMT were analyzed.The clinical prognosis within 90 days after EMT was evaluated and its associated factors were analyzed.Results 14 out of 16 patients were successfully treated with EMT.Modified Treatment in Cerebral Ischemia Scale(mTICI) 3 or 2b level was successful achieved in 11 cases(11/16).There was no symptomatic intracranial hemorrhage,whereas 1 case(1/16) of failed endoscopic stent retrieval occurred,and 1 case(1/16) of iatrogenic dissection.The follow-up within 90 days after EMT showed that 5 cases(5/16) died.The Modified Rankin Scale (mRS) score of the survivals was(2.0±1.4).Seven cases(7/16) with mRS score ≤ 2 were found with favorable prognosis,but other 9 cases(9/16)(including 4 with mRS score > 2 and 5 deaths) with poor prognosis.Sex,preprocedural NIHSS score,preprocedural pc-ASPECTS,being comatose or hemiplegia in consultation,duration between the onset of stroke symptoms and admission time,duration between the onset of stroke symptoms and recanalization time differed significantly between patients with good prognosis and those with poor prognosis(P<0.05).Conclusion EMT with Solitaire AB stent could achieve a high recanalization rate and improve the clinical prognosis in ABAO patients.