Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
J Stroke Cerebrovasc Dis. 2013 Jul;22(5):694-9. doi: 10.1016/j.jstrokecerebrovasdis.2011.10.010. Epub 2011 Dec 11.
A significant proportion of patients with infarcts from large-vessel lesions have shown a poor response to systemic thrombolysis. Stents have been used to recanalize occluded or severely stenosed intracranial arteries in patients with acute stroke. This study evaluated the feasibility, efficacy, and safety of intracranial artery recanalization for acute middle cerebral artery (MCA) occlusion using emergent angioplasty and stent placement without thrombolysis. All patients from a retrospectively collected database who met the inclusion criteria and were treated with an intracranial stent for acute MCA occlusion were included. Treatment comprised angioplasty and stenting without interventional thrombolytic therapy. Recanalization was assessed by angiography immediately after stent placement based on the Thrombolysis in Myocardial Infarction (TIMI) score. Complications related to the procedure and outcomes were assessed. Neurologic status was evaluated before and after treatment. Eleven patients were treated with emergent angioplasty and stent placement. Partial or complete recanalization (TIMI 2 and 3) was achieved in 11 patients (100%) assessed by digital subtraction angiography immediately after MCA stenting. One patient died due to reocclusion of MCA 2 days after the procedure. Among the survivors, 7 patients (70%) had a good outcome (modified Rankin Scale score, 0-2) and 3 patients (30%) had a moderate outcome (modified Rankin Scale score, 3). Follow-up computed tomography angiography or magnetic resonance angiography revealed mild restenosis in 2 of the 10 patients. This preliminary experience demonstrates the technical feasibility and high rate of recanalization with emergent angioplasty and stenting without thrombolysis in patients with acute MCA occlusion.
相当比例的大血管病变所致梗死患者对全身溶栓治疗反应不佳。支架已被用于急性脑卒中患者闭塞或严重狭窄的颅内动脉再通。本研究评估了在不溶栓的情况下，紧急血管成形术和支架置入术治疗急性大脑中动脉（MCA）闭塞的可行性、疗效和安全性。所有符合纳入标准并接受颅内支架治疗急性 MCA 闭塞的患者均来自回顾性收集的数据库。治疗包括血管成形术和支架置入术，不进行介入性溶栓治疗。支架置入后立即根据血栓溶解心肌梗死（TIMI）评分进行血管造影评估再通情况。评估与手术相关的并发症和结果。治疗前后评估神经功能状态。11 例患者接受紧急血管成形术和支架置入术治疗。11 例患者（100%）经数字减影血管造影评估MCA 支架置入后即刻达到部分或完全再通（TIMI 2 和 3）。1 例患者因术后 2 天 MCA 再闭塞死亡。幸存者中，7 例（70%）预后良好（改良 Rankin 量表评分 0-2），3 例（30%）预后中等（改良 Rankin 量表评分 3）。10 例患者中有 2 例在随访时计算机断层血管造影或磁共振血管造影显示轻度再狭窄。这初步经验表明，在急性 MCA 闭塞患者中，不溶栓的紧急血管成形术和支架置入术具有技术可行性和高再通率。
