Department of Interventional Neuroradiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
AJNR Am J Neuroradiol. 2013 May;34(5):1044-8. doi: 10.3174/ajnr.A3329. Epub 2012 Nov 1.
Acute vertebrobasilar occlusion is an ominous disease with few proved effective treatments. Experience with stent retrievers is scarce and limited to combined therapies (stent retrievers associated with previous intravenous fibrinolysis, intra-arterial thrombolysis, or other mechanical devices). We present our experience with 18 patients treated with direct thrombectomy by using stent retrievers.
Eighteen patients with vertebrobasilar occlusion were treated with direct thrombectomy by using stent retrievers at our hospital. The mean age was 67.5 years. Clinical presentation was sudden deterioration in consciousness level in 61.2% and progressive or fluctuating brain stem symptoms in 38.8%. Stroke subtype (TOAST) was atherothrombotic (33.3%), undetermined (33.3%), cardioembolic (27.7%), and of unusual etiology (5.5%).
The occlusion site was the vertebral artery in 1 case, proximal basilar artery in 4, middle basilar artery in 6, distal basilar artery in 5, and unilateral posterior cerebral artery in 2 cases. SRs included the Solitaire AB in 8 cases, Solitaire FR in 5 cases, and Trevo Pro in 5 cases. An 8F Merci balloon guide catheter was used in 15 patients, and a Neuron 6F, in 3 patients. Post-clot retrieval definitive intracranial stents were used in 5 patients (27.7%). Postprocedural TICI ≥ 2b was achieved in 17 patients (94.4%). Clinically, 72.2% of patients experienced an improved NIHSS score at discharge, 22.2% died, and in 5.5% the NIHSS scores did not change. The mRS score at 3 months was 0-2 in 9 patients (50%) and 3-5 in 5 patients (27.7%).
Thrombectomy with stent retrievers is feasible in the treatment of vertebrobasilar occlusion. These initial results must be confirmed by further prospective studies with a larger number of cases.
急性椎基底动脉闭塞是一种预后凶险的疾病，目前有效的治疗方法寥寥无几。支架取栓术的经验有限，仅限于联合治疗（支架取栓术联合静脉内溶栓、动脉内溶栓或其他机械取栓方法）。我们在此报告 18 例接受支架取栓术直接血栓切除术治疗的患者的经验。
18 例椎基底动脉闭塞患者在我院接受支架取栓术直接血栓切除术治疗。平均年龄为 67.5 岁。临床表现为 61.2%的患者意识水平突然恶化，38.8%的患者为进展性或波动性脑干症状。卒中亚型（TOAST）为动脉粥样硬化血栓形成（33.3%）、原因不明（33.3%）、心源性栓塞（27.7%）和罕见病因（5.5%）。
闭塞部位为 1 例椎动脉，4 例基底动脉近端，6 例基底动脉中段，5 例基底动脉远端，2 例单侧大脑后动脉。支架取栓术采用 Solitaire AB 8 例，Solitaire FR 5 例，Trevo Pro 5 例。15 例患者采用 8F Merci 球囊导引导管，3 例患者采用 Neuron 6F。5 例患者（27.7%）在血栓切除后使用了确定性颅内支架。17 例患者（94.4%）术后 TICI≥2b。临床结果显示，出院时 72.2%的患者 NIHSS 评分改善，22.2%的患者死亡，5.5%的患者 NIHSS 评分无变化。3 个月 mRS 评分 0-2 分 9 例（50%），3-5 分 5 例（27.7%）。
支架取栓术治疗椎基底动脉闭塞是可行的。这些初步结果需要通过进一步的前瞻性研究，纳入更多的病例来证实。
