Fu Maolin, He Wenqin, Dai Weizheng, Ye Yingan, Ruan Zhifang, Wang Shuanghu, Xie Huifang
Department of Neurology, The 180th Hospital of PLA, Quanzhou, Fujian, China (mainland).
Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland).
Med Sci Monit. 2016 Apr 19;22:1302-8. doi: 10.12659/msm.895908.
BACKGROUND Thrombolysis with rtPA is the only accepted drug therapy for acute ischemic stroke. Since acute cerebral stroke is so pervasive, newly developed recanalization methods have the potential for wide-ranging impacts on patient health and safety. We explored the efficacy and safety of Solitaire stent arterial embolectomy in the treatment of acute cardiogenic cerebral embolism. MATERIAL AND METHODS Between October 2012 and June 2015, 17 patients underwent Solitaire stent arterial embolectomy, either alone or in combination with rtPA intravenous thrombolysis, to treat acute cardiogenic cerebral embolism. Sheath placement time, vascular recanalization time, number of embolectomy attempts, and IV rtPA dose and time were recorded. Success and safety of the recanalization procedure, as well as clinical outcomes, were assessed. These results were compared to 16 control patients who were treated using only rtPA IV thrombolysis. RESULTS Full recanalization of the occluded arteries was achieved in 15 (88.2%) of the Solitaire stent patients. NIH Stroke Scale scores of embolectomy patients improved by an average of 12.59 ± 8.24 points between admission and discharge, compared to 5.56 ± 5.96 in the control group (P<0.05). Glasgow Coma Score improvement between admission and discharge was also significantly higher in the embolectomy group (P<0.05). There was no significant difference in symptomatic intracerebral hemorrhage, high perfusion encephalopathy, incidence of hernia, or mortality between the 2 groups (P>0.05). CONCLUSIONS Solitaire stent embolectomy is a safe and effective alternative to simple venous thrombolytic therapy, and it can significantly improve short-term neurological function and long-term prognosis in acute cardiogenic cerebral embolism.
背景 重组组织型纤溶酶原激活剂（rtPA）溶栓是急性缺血性卒中唯一被认可的药物治疗方法。由于急性脑卒病情普遍，新开发的血管再通方法可能对患者健康和安全产生广泛影响。我们探讨了Solitaire支架动脉取栓术治疗急性心源性脑栓塞的疗效和安全性。材料与方法 2012年10月至2015年6月，17例患者接受了Solitaire支架动脉取栓术，单独或联合rtPA静脉溶栓，以治疗急性心源性脑栓塞。记录鞘管置入时间、血管再通时间、取栓尝试次数以及静脉rtPA剂量和时间。评估再通手术的成功率和安全性以及临床结局。将这些结果与16例仅接受rtPA静脉溶栓治疗的对照患者进行比较。结果 Solitaire支架组15例（88.2%）患者闭塞动脉实现完全再通。取栓患者美国国立卫生研究院卒中量表（NIHSS）评分在入院至出院期间平均改善12.59±8.24分，而对照组为5.56±5.96分（P<0.05）。取栓组入院至出院期间格拉斯哥昏迷评分（GCS）改善也显著更高（P<0.05）。两组在症状性脑出血、高灌注脑病、疝发生率或死亡率方面无显著差异（P>0.05）。结论 Solitaire支架取栓术是单纯静脉溶栓治疗的一种安全有效的替代方法，可显著改善急性心源性脑栓塞患者的短期神经功能和长期预后。
