Rentzos A, Lundqvist C, Karlsson J-E, Vilmarsson V, Schnabel K, Wikholm G
From the Departments of Interventional and Diagnostic Neuroradiology (A.R., V.V., K.S., G.W.)
Neurology (C.L., J.-E.K.), Sahlgrenska University Hospital, Gothenburg, Sweden.
AJNR Am J Neuroradiol. 2014 Oct;35(10):1936-41. doi: 10.3174/ajnr.A3997. Epub 2014 Jun 19.
Intra-arterial treatment of proximal occlusions in the cerebral circulation have become an important tool in the management of acute ischemic stroke. Our goal was to evaluate the safety and efficacy of intra-arterial acute ischemic stroke treatment performed in our institution in consecutive patients with anterior circulation occlusion during 2000-2011.
We identified, in our data base, 156 consecutive cases with anterior acute ischemic stroke treated intra-arterially during 2000-2011. Stroke severity was defined according to the National Institutes of Health Stroke Scale, the results of the procedure were defined according to the modified Thrombolysis in Cerebral Infarction score, and clinical outcome was defined according to the modified Rankin scale, with favorable outcome ≤2 at 90 days.
The mean admission NIHSS score was 19.4 (median, 20), with a mean time from stroke onset to groin puncture of 197 minutes (median, 171 minutes). The embolectomy tool of choice was the Amplatz GooseNeck snare (83%). Successful recanalization (modified TICI 2b +3) was seen in 74% of cases. A mRS ≤ 2 at 90 days was seen in 42% with a mortality rate of 17% and symptomatic intracerebral hemorrhage in 4%.
A high recanalization rate was obtained with the Amplatz GooseNeck snare without any device-related complications. Favorable outcome, mortality, and symptomatic intracerebral hemorrhage are comparable with results of newer embolectomy devices.
脑循环近端闭塞的动脉内治疗已成为急性缺血性卒中管理的一项重要工具。我们的目标是评估2000年至2011年期间在我们机构对连续的前循环闭塞患者进行动脉内急性缺血性卒中治疗的安全性和有效性。
我们在数据库中识别出2000年至2011年期间接受动脉内治疗的156例连续性前循环急性缺血性卒中病例。根据美国国立卫生研究院卒中量表定义卒中严重程度，根据改良脑梗死溶栓评分定义手术结果，根据改良Rankin量表定义临床结局，90天时良好结局≤2分。
入院时美国国立卫生研究院卒中量表平均评分为19.4分（中位数为20分），从卒中发作到股动脉穿刺的平均时间为197分钟（中位数为171分钟）。首选的取栓工具是Amplatz鹅颈圈套器（83%）。74%的病例实现了成功再通（改良脑梗死溶栓分级2b +3级）。90天时改良Rankin量表评分≤2分的患者占比42%，死亡率为17%，有症状性颅内出血的患者占比4%。
使用Amplatz鹅颈圈套器获得了较高的再通率，且无任何与器械相关的并发症。良好结局、死亡率和有症状性颅内出血情况与更新的取栓器械的结果相当。
