From the Departments of Neuroradiology (S.S., M.M., C. Herweh, M.P., S.H., M.B., S.R.).
AJNR Am J Neuroradiol. 2014 Apr;35(4):741-6. doi: 10.3174/ajnr.A3763. Epub 2013 Oct 24.
In past years, thrombectomy has become a widely used procedure in interventional neuroradiology for the treatment of acute intracranial occlusions. However, in 10-20% of patients, there are additional occlusions or stenotic lesions of the ipsilateral cervical internal carotid artery. The purpose of this study was to evaluate the feasibility of emergency carotid artery stent placement in combination with intracranial thrombectomy and the clinical outcome of the treated patients.
We analyzed clinical and angiographic data of patients who underwent emergency cervical ICA stent placement and intracranial thrombectomy with stent-retriever devices in our institution between November 2009 and July 2012. Recanalization was assessed according to the Thrombolysis in Cerebral-Infarction score. Clinical outcome was evaluated at discharge (NIHSS) and after 3 months (mRS).
Overall, 24 patients were treated. The mean age was 67.2 years; mean occlusion time, 230.2 minutes. On admission, the median NIHSS score was 18. In all patients, the Thrombolysis in Cerebral Infarction score was zero before the procedure. Stent implantation was feasible in all cases. In 15 patients (62.5%), a Thrombolysis in Cerebral Infarction score ≥ 2b could be achieved. Six patients (25%) improved ≥10 NIHSS points between admission and discharge. After 90 days, the median mRS score was 3.0. Seven patients (29.2%) had a good clinical outcome (mRS 0-2), and 4 patients (16.6%) died, 1 due to fatal intracranial hemorrhage. Overall, symptomatic intracranial hemorrhage occurred in 4 patients (16.6%).
Emergency ICA stent implantation was technically feasible in all patients, and the intracranial recanalization Thrombolysis in Cerebral Infarction score of ≥2b was reached in a high number of patients. Clinical outcome and mortality seem to be acceptable for a cohort with severe stroke. However, a high rate of symptomatic intracranial hemorrhage occurred in our study.
在过去的几年中，血管内神经介入治疗中取栓术已成为治疗急性颅内闭塞的常用方法。然而，在 10-20%的患者中，同侧颈内动脉存在其他闭塞或狭窄病变。本研究旨在评估在紧急情况下行颈动脉支架置入术联合颅内取栓术的可行性，以及治疗患者的临床转归。
我们分析了 2009 年 11 月至 2012 年 7 月在我院行紧急颈内动脉支架置入术和支架取栓装置治疗的患者的临床和血管造影资料。根据血栓溶解治疗脑梗死（Thrombolysis in Cerebral Infarction，TICI）评分评估再通情况。出院时（NIHSS）和 3 个月后（mRS）评估临床转归。
共治疗 24 例患者。平均年龄为 67.2 岁；平均闭塞时间为 230.2 分钟。入院时，中位数 NIHSS 评分为 18。所有患者在操作前 TICI 评分为 0。所有病例均可行支架植入术。在 15 例患者（62.5%）中，TICI 评分为≥2b。6 例患者（25%）入院至出院时 NIHSS 评分改善≥10 分。90 天后，中位数 mRS 评分为 3.0。7 例患者（29.2%）临床结局良好（mRS 0-2），4 例患者（16.6%）死亡，1 例因致命性颅内出血死亡。总体而言，4 例患者（16.6%）发生症状性颅内出血。
所有患者的紧急颈内动脉支架植入术均可行，且多数患者达到了颅内再通 TICI 评分≥2b。对于卒中严重的患者，临床转归和死亡率似乎可以接受。然而，本研究中症状性颅内出血发生率较高。
