Fields J D, Lutsep H L, Rymer M R, Budzik R F, Devlin T G, Baxter B W, Malek R, Padidar A M, Barnwell S L, Smith W S
Interventional Neuroradiology, Oregon Health & Science University, Portland, OR 07239-3098, USA.
Interv Neuroradiol. 2012 Mar;18(1):74-9. doi: 10.1177/159101991201800110. Epub 2012 Mar 16.
Arterial dissections account for 2% of strokes in all age groups, and up to 25% in patients aged 45 years or younger. The safety of endovascular intervention in this patient population is not well characterized. We identified all patients in the Merci registry - a prospective, multi-center post-market database enrolling patients treated with the Merci Retriever thrombectomy device - with arterial dissection as the most likely stroke etiology. Stroke presentation and procedural details were obtained prospectively; data regarding procedural complications, intracerebral hemorrhage (ICH), and the use of stenting of the dissected artery were obtained retrospectively. Of 980 patients in the registry, ten were identified with arterial dissection (8/10 ICA; 2/10 vertebrobasilar). The median age was 48 years with a baseline NIH stroke scale score of 16 and median time to treatment of 4.9 h. The procedure resulted in thrombolysis in cerebral ischemia (TICI) scores of 2a or better in eight out of ten and TICI 2b or better in six out of ten patients. Stenting of the dissection was performed in four of nine (44%). The single complication (1/9; 11%) - extension of a dissected carotid artery - was treated effectively with stenting. No symptomatic ICH or stroke in a previously unaffected territory occurred. A favorable functional outcome was observed in eight out of ten patients. Despite severe strokes on presentation, high rates of recanalization (8/10) and favorable functional outcomes (8/10) were observed. These results suggest that mechanical thrombectomy in patients with acute stroke resulting from arterial dissection is feasible, safe, and may be associated with favorable functional outcomes.
动脉夹层在所有年龄组的中风病例中占2%，在45岁及以下患者中占比高达25%。这一患者群体中血管内介入治疗的安全性尚未得到充分描述。我们在Merci注册研究中确定了所有以动脉夹层为最可能的中风病因的患者，该研究是一个前瞻性、多中心的上市后数据库，纳入了接受Merci取栓装置治疗的患者。前瞻性地获取了中风表现和手术细节；回顾性地获取了有关手术并发症、脑出血（ICH）以及夹层动脉支架置入使用情况的数据。在该注册研究的980例患者中，有10例被确定为动脉夹层（8例颈内动脉；2例椎基底动脉）。中位年龄为48岁，基线美国国立卫生研究院中风量表评分为16分，中位治疗时间为4.9小时。该手术使十分之八的患者脑缺血溶栓（TICI）评分达到2a或更高，十分之六的患者TICI评分达到2b或更高。九例患者中有四例（44%）进行了夹层动脉支架置入。唯一的并发症（1/9；11%）——颈动脉夹层扩展——通过支架置入得到有效治疗。未发生有症状的脑出血或先前未受影响区域的中风。十分之八的患者观察到良好的功能结局。尽管发病时中风严重，但再通率（8/10）和功能结局良好率（8/10）较高。这些结果表明，对由动脉夹层导致的急性中风患者进行机械取栓是可行、安全的，并且可能与良好的功能结局相关。
