Kim Seong Mook, Sohn Sung-Il, Hong Jeong-Ho, Chang Hyuk-Won, Lee Chang-Young, Kim Chang-Hyun
Department of Neurosurgery, Keimyung University School of Medicine, Daegu, Korea.
Department of Neurology, Keimyung University School of Medicine, Daegu, Korea.
J Korean Neurosurg Soc. 2015 Nov;58(5):419-25. doi: 10.3340/jkns.2015.58.5.419. Epub 2015 Nov 30.
Acute vertebrobasilar artery occlusion (AVBAO) is a devastating disease with a high mortality rate. One of the most important factors affecting favorable clinical outcome is early recanalization. Mechanical thrombectomy is an emerging treatment strategy for achieving a high recanalization rates. However, thrombectomy alone can be insufficient to complete recanalization, especially for acute stroke involving large artery atheromatous disease. The purpose of this study is to investigate the safety and efficacy of mechanical thrombectomy in AVBAO.
Fourteen consecutive patients with AVBAO were treated with mechanical thrombectomy. Additional multimodal treatments were intra-arterial (IA) thrombolysis, balloon angioplasty, or permanent stent placement. Recanalization by thrombectomy alone and multimodal treatments were assessed by the Thrombolysis in Cerebral Infarction (TICI) score. Clinical outcome was determined using the National Institutes of Health Stroke Scale (NIHSS) at 7 days and the modified Rankin Scale (mRS) at 3 months.
Thrombectomy alone and multimodal treatments were performed in 10 patients (71.4%) and 4 patients (28.6%), respectively. Successful recanalization (TICI 2b-3) was achieved in 11 (78.6%). Among these 11 patients, 3 (27.3%) underwent multimodal treatment due to underlying atherosclerotic stenosis. Ten (71.4%) of the 14 showed NIHSS score improvement of >10. Overall mortality was 3 (21.4%) of 14.
We suggest that mechanical thrombectomy is safe and effective for improving recanalization rates in AVBAO, with low complication rates. Also, in carefully selected patients after the failure of recanalization by thrombectomy alone, additional multimodal treatment such as IA thrombolysis, balloons, or stents can be needed to achieve successful recanalization.
急性椎基底动脉闭塞（AVBAO）是一种死亡率很高的严重疾病。影响良好临床结局的最重要因素之一是早期再通。机械取栓术是一种能实现高再通率的新兴治疗策略。然而，单纯取栓术可能不足以完成再通，尤其是对于涉及大动脉粥样硬化疾病的急性卒中。本研究的目的是探讨机械取栓术治疗AVBAO的安全性和有效性。
连续14例AVBAO患者接受机械取栓术治疗。额外的多模式治疗包括动脉内（IA）溶栓、球囊血管成形术或永久性支架置入。通过脑梗死溶栓（TICI）评分评估单纯取栓术和多模式治疗的再通情况。使用美国国立卫生研究院卒中量表（NIHSS）在7天时和改良Rankin量表（mRS）在3个月时确定临床结局。
分别有10例（71.4%）和4例（28.6%）患者接受了单纯取栓术和多模式治疗。11例（78.6%）实现了成功再通（TICI 2b - 3）。在这11例患者中，3例（27.3%）因潜在的动脉粥样硬化狭窄接受了多模式治疗。14例患者中有10例（71.4%）NIHSS评分改善>10分。总死亡率为14例中的3例（21.4%）。
我们认为机械取栓术对于提高AVBAO的再通率是安全有效的，并发症发生率低。此外，对于经单纯取栓术再通失败后经过精心挑选的患者，可能需要额外的多模式治疗，如IA溶栓、球囊或支架，以实现成功再通。
