Kulcsár Zsolt, Bonvin Christophe, Lovblad Karl-Olof, Gory Benjamin, Yilmaz Hasan, Sztajzel Roman, Rufenacht Daniel
Neurointerventional Division, Geneva University Hospital, Geneva, Switzerland,
Clin Neuroradiol. 2010 Mar;20(1):54-60. doi: 10.1007/s00062-010-9024-x. Epub 2010 Feb 28.
Major cerebral thromboembolism often resists recanalization with currently available techniques. The authors present their initial experience with a self-expanding stent for use in intracranial vascular reconstruction, permitting immediate recanalization of acute thromboembolic occlusions of the anterior circulation.
Patients treated with the Cordis Enterprise™ self-expanding intracranial stent system for acute thromboembolic occlusion of the major anterior cerebral arteries were included. Treatment comprised systemic and intraarterial thrombolysis, mechanical thrombectomy, and stent placement. Stent deployment, recanalization rate by means of Thrombolysis In Cerebral Infarction (TICI) scores and the clinical outcome were all assessed.
Six patients presenting with acute carotid T (n = 2) or proximal middle cerebral artery occlusion (n = 4) were treated. The mean National Institutes of Health Stroke Scale (NIHSS) score at presentation was 14; the mean age was 57 years. Successful stent deployment and immediate recanalization were achieved in all six with a TICI score of ≥ 2. Neither distal emboli nor any procedure-related complications were encountered. One patient developed symptomatic intracerebral hemorrhage and two patients needed decompressive craniectomy after treatment. The mean NIHSS score at 10 days was 10, but only one patient showed a complete recovery at 3 months.
Intracranial placement of the Enterprise™ self-expanding stent has proven to be feasible and efficient in achieving immediate recanalization of occluded main cerebral arteries. The use of antiplatelet therapy after treatment may, however, increase the risk of reperfusion intracerebral hemorrhage.
严重的大脑血栓栓塞通常难以通过现有技术实现再通。作者介绍了他们使用自膨式支架进行颅内血管重建的初步经验，该方法可使前循环急性血栓栓塞性闭塞立即再通。
纳入使用Cordis Enterprise™自膨式颅内支架系统治疗大脑前动脉主要分支急性血栓栓塞性闭塞的患者。治疗包括全身及动脉内溶栓、机械取栓和支架置入。评估支架置入情况、采用脑梗死溶栓（TICI）评分的再通率及临床结局。
6例患者接受治疗，其中2例为急性颈动脉T段闭塞，4例为大脑中动脉近端闭塞。就诊时美国国立卫生研究院卒中量表（NIHSS）评分平均为14分；平均年龄57岁。6例患者均成功置入支架并立即实现再通，TICI评分≥2。未出现远端栓子及任何与手术相关的并发症。1例患者出现有症状的脑出血，2例患者治疗后需要行去骨瓣减压术。10天时NIHSS评分平均为10分，但3个月时仅1例患者完全恢复。
已证明Enterprise™自膨式支架颅内置入对于实现闭塞的大脑主要动脉立即再通是可行且有效的。然而，治疗后使用抗血小板治疗可能会增加再灌注性脑出血的风险。
