Nogueira Raul G, Schwamm Lee H, Buonanno Ferdinando S, Koroshetz Walter J, Yoo Albert J, Rabinov James D, Pryor Johnny C, Hirsch Joshua A
Department of Radiology, Endovascular Neurosurgery/Interventional Neuroradiology Section, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Neuroradiology. 2008 Apr;50(4):331-40. doi: 10.1007/s00234-007-0340-z. Epub 2008 Jan 3.
The use of coronary balloons in the cerebral vasculature is limited due to their poor trackability and increased risk of vessel injury. We report our experience using more compliant elastomer balloons for thrombus resistant to intraarterial (IA) pharmacological and mechanical thrombolysis in acute stroke.
We retrospectively analyzed 12 consecutive patients with an occluded intracranial artery treated with angioplasty using a low-pressure elastomer balloon. Angiograms were graded according to the Thrombolysis in Cerebral Infarction (TICI) and Qureshi grading systems. Outcomes were categorized as independent (modified Rankin scale, mRS, score <or=2), dependent (mRS score 3-5), or dead (mRS score 6).
Included in the study were 12 patients (mean age 66+/-17 years, range 31-88 years; mean baseline National Institutes of Health stroke scale score 17+/-3, range 12-23). The occlusion sites were: internal carotid artery (ICA) terminus (five patients, including two concomitant cervical ICA occlusions), M1 segment (two patients), and basilar artery (two patients). Pharmacological treatment included intravenous (IV) t-PA only (two patients), IA urokinase only (nine patients), both IV t-PA and IA urokinase (one patient), and IV and/or IA eptifibatide (eight patients). Mean time to treatment was 5.9+/-3.9 h (anterior circulation) and 11.0+/-7.2 h (posterior circulation). Overall recanalization rate (TICI grade 2/3) was 91.6%. Procedure-related morbidity occurred in one patient (distal posterior inferior cerebellar artery embolus). There were no symptomatic hemorrhages. Outcomes at 90 days were independent (five patients), dependent (three patients) and dead (four patients, all due to progression of stroke with withdrawal of care).
Angioplasty of acutely occluded intracranial arteries with low-pressure elastomer balloons results in high recanalization rates with an acceptable degree of safety. Prior use of thrombolytics may increase the chances of recanalization, and glycoprotein IIb-IIIa inhibitors may be helpful in preventing reocclusion and in increasing patency rates.
冠状动脉球囊在脑血管系统中的应用受到限制，因为其跟踪性差且血管损伤风险增加。我们报告了使用更顺应性的弹性体球囊治疗急性卒中中对动脉内（IA）药物和机械溶栓耐药的血栓的经验。
我们回顾性分析了连续12例接受低压弹性体球囊血管成形术治疗的颅内动脉闭塞患者。血管造影根据脑梗死溶栓（TICI）和库雷希分级系统进行分级。结果分为独立（改良Rankin量表，mRS，评分≤2）、依赖（mRS评分3 - 5）或死亡（mRS评分6）。
研究纳入12例患者（平均年龄66±17岁，范围31 - 88岁；平均基线美国国立卫生研究院卒中量表评分17±3，范围12 - 23）。闭塞部位为：颈内动脉（ICA）末端（5例患者，包括2例合并颈段ICA闭塞）、M1段（2例患者）和基底动脉（2例患者）。药物治疗包括仅静脉注射（IV）t - PA（2例患者）、仅IA尿激酶（9例患者）、IV t - PA和IA尿激酶两者（1例患者）以及IV和/或IA依替巴肽（8例患者）。治疗的平均时间为5.9±3.9小时（前循环）和11.0±7.2小时（后循环）。总体再通率（TICI 2/3级）为91.6%。1例患者发生与手术相关的并发症（小脑后下动脉远端栓子）。没有症状性出血。90天时的结果为独立（5例患者）、依赖（3例患者）和死亡（4例患者，均因卒中进展且放弃治疗）。
使用低压弹性体球囊对急性闭塞的颅内动脉进行血管成形术可获得较高的再通率且安全性可接受。先前使用溶栓药物可能会增加再通的机会，糖蛋白IIb - IIIa抑制剂可能有助于预防再闭塞并提高通畅率。
