Department of Neurology; Stroke Center, Inje University, Ilsan Paik Hospital, Gyeonggi-do, South Korea.
Neurol India. 2012 Jul-Aug;60(4):400-5. doi: 10.4103/0028-3886.100701.
Intravenous tissue plasminogen activator (TPA) has limited efficacy in proximal large vessel occlusions. This study was to assess the safety and efficacy of mechanical thrombectomy with a retrievable Solitaire stent in acute large artery occlusions .
This is a single center study enrolling patients treated with Solitaire-assisted thrombectomy between November 2010 and March 2011. Inclusion criteria were severe stroke of National Institutes of Health Stroke Scale (NIHSS) score ≥10, treatment initiation within 6 hours from onset, and an angiographically verified occlusion of proximal middle cerebral artery (MCA) or internal carotid artery (ICA). The primary outcome was recanalization defined as Thrombolysis in Cerebral Infarct (TICI) reperfusion grade 2b/3. Secondary outcomes were good functional outcome at 3 months (modified Rankin Scale [mRS] ≤2), early substantial neurological improvement (NIHSS score improvement ≥8 at 24 hours), and symptomatic hemorrhagic transformation (SHT).
Ten patients were consecutively enrolled: Age: 72.4 5.7 years; female: 70%; baseline median NIHSS score: 19.5; and ICA occlusion in 50% and M1 portion of MCA occlusion in 50%. Six patients received intravenous TPA before intra-arterial treatment, and five patients were treated with adjuvant intra-arterial urokinase. Successful recanalization was achieved in 7 (70%) patients. Four (40%) patients had a good functional outcome at 3 months, and three (30%) patients had an early substantial neurological improvement. SHT occurred in two patients (20%), and 3-month mortality rate was 30%. There was no procedure-related complication.
Mechanical thrombectomy with the Solitaire device can effectively recanalize proximal large vessel occlusions, and potentially improves clinical outcome.
静脉注射组织型纤溶酶原激活物（tissue plasminogen activator，TPA）治疗近端大血管闭塞的疗效有限。本研究旨在评估可回收 Solitaire 支架机械取栓治疗急性大动脉闭塞的安全性和有效性。
这是一项单中心研究，纳入 2010 年 11 月至 2011 年 3 月接受 Solitaire 辅助取栓治疗的患者。纳入标准为美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分≥10 分的严重卒中，发病 6 小时内开始治疗，以及经血管造影证实近端大脑中动脉（middle cerebral artery，MCA）或颈内动脉（internal carotid artery，ICA）闭塞。主要转归为溶栓治疗脑梗死（thrombolysis in cerebral infarction，TICI）再通分级 2b/3 级。次要转归为 3 个月时良好的功能结局（改良 Rankin 量表[modified Rankin Scale，mRS]≤2 分）、早期显著神经功能改善（24 小时 NIHSS 评分改善≥8 分）和症状性出血性转化（symptomatic hemorrhagic transformation，SHT）。
连续纳入 10 例患者：年龄 72.4±5.7 岁；女性占 70%；基线 NIHSS 中位数为 19.5；ICA 闭塞占 50%，MCA M1 段闭塞占 50%。6 例患者在动脉内治疗前接受了静脉 TPA，5 例患者接受了辅助性动脉内尿激酶治疗。7 例（70%）患者实现了再通。4 例（40%）患者在 3 个月时获得了良好的功能结局，3 例（30%）患者出现了早期显著的神经功能改善。2 例（20%）患者发生 SHT，3 个月死亡率为 30%。无手术相关并发症。
Solitaire 装置机械取栓可有效再通近端大血管闭塞，可能改善临床结局。
