Hiramatsu Ryo, Furuse Motomasa, Yagi Ryokichi, Ohnishi Hiroyuki, Ikeda Naokado, Nonoguchi Naosuke, Kawabata Shinji, Miyachi Shigeru, Kuroiwa Toshihiko
Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Osaka, Japan.
Interv Neuroradiol. 2018 Feb;24(1):57-63. doi: 10.1177/1591019917740101. Epub 2017 Nov 29.
Endovascular thrombectomy is recommended for a persistent ischemic penumbra if recanalization cannot be achieved by the intravenous (IV) administration of recombinant tissue-plasminogen activator (rt-PA) alone. Although endovascular thrombectomy is a powerful treatment for major cerebral artery occlusion, the monitoring of recanalization and reperfusion during acute ischemic stroke presents a therapeutic challenge, and a previous study reported the usefulness of near-infrared spectroscopy (NIRS) for intraoperative monitoring during emergency endovascular thrombectomy for acute large ischemic stroke. Here we present our experience with a relevant case series. We applied NIRS monitoring during endovascular thrombectomy in two patients with large ischemic stroke following carotid artery occlusion and one patient with a non-large ischemic stroke caused by a distal middle cerebral artery (MCA) occlusion. In the patients with large ischemic stroke, complete recanalization of the internal carotid artery was achieved, and NIRS revealed a very good regional oxygen saturation (rSO) response. By contrast, in the patient with non-large ischemic stroke, the rSO did not change, despite complete recanalization of the distal MCA. Our findings suggest the limited usefulness of intraoperative NIRS monitoring during emergency endovascular thrombectomy for non-large acute ischemic stroke caused by a distal MCA occlusion. However, intraoperative NIRS monitoring could be used practically to detect recanalization of the major artery during thrombectomy and early IV rt-PA administration in cases involving major artery occlusion.
如果仅通过静脉注射重组组织型纤溶酶原激活剂（rt-PA）无法实现再通，对于持续存在的缺血半暗带，推荐进行血管内血栓切除术。尽管血管内血栓切除术是治疗大脑中动脉主要闭塞的有效方法，但急性缺血性卒中期间再通和再灌注的监测是一项治疗挑战，并且先前的一项研究报道了近红外光谱（NIRS）在急性大面积缺血性卒中紧急血管内血栓切除术中用于术中监测的有效性。在此，我们介绍我们在相关病例系列中的经验。我们在两名因颈动脉闭塞导致大面积缺血性卒中的患者以及一名因大脑中动脉（MCA）远端闭塞导致非大面积缺血性卒中的患者进行血管内血栓切除术期间应用了NIRS监测。在大面积缺血性卒中患者中，实现了颈内动脉的完全再通，并且NIRS显示出非常好的局部氧饱和度（rSO）反应。相比之下，在非大面积缺血性卒中患者中，尽管MCA远端完全再通，但rSO并未改变。我们的研究结果表明，在因MCA远端闭塞导致的非大面积急性缺血性卒中的紧急血管内血栓切除术中，术中NIRS监测的有效性有限。然而，术中NIRS监测实际上可用于在涉及主要动脉闭塞的病例中，在血栓切除术和早期静脉注射rt-PA期间检测主要动脉的再通情况。
