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“S”形颈动脉急性缺血性夹层:使用可解脱Solitaire AB支架的“一站式”价值

Acute ischemic dissection of an "S"-shaped carotid artery: The "one-stop" value of using a detachable Solitaire AB stent.

作者信息

Shi Hongchao, Hou Jiankang, Shi Wanyin, Gu Jianping

机构信息

Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China.

Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68, Changle Road, Nanjing 210006, China.

出版信息

J Clin Neurosci. 2018 Jul;53:177-182. doi: 10.1016/j.jocn.2018.04.075. Epub 2018 May 9.

Abstract

This study aimed to evaluate the efficacy and safety of endovascular repair using detachable Solitaire AB stents for acute ischemic dissection of "S"-shaped carotid arteries. From May 2015 to December 2016, a total of 127 patients with acute ischemic stroke (AIS) underwent endovascular treatment in our center. Among them, five AISs were due to acute dissection of an "S"-shaped carotid artery. Coexisting carotid embolism was identified in all five patients, who first underwent successful Solitaire AB stent-based retrieval of the embolism. All patients then underwent Solitaire AB stenting to reopen the occluded carotid arteries, all of which were successfully recanalized. There were no procedure-related complications, except for minor hemorrhage transformation in one patient. The mean NIHSS scores were 12 ± 3.7 and 3.8 ± 3.4 at admission and 90 days after stenting, respectively (P = 0.018). The median modified Rankin Scale score at 90 days was 2.0 ± 1.4. Follow-up computed tomography angiography demonstrated in-stent patency in four of the five patients. Dissection of an "S"-shaped carotid artery infrequently leads to AIS. Such dissected arteries can be safely and reliably repaired by this stenting, ensuring successful reconstruction of the carotid arterial circulation.

摘要

本研究旨在评估使用可解脱的Solitaire AB支架进行血管内修复治疗“S”形颈动脉急性缺血性夹层的疗效和安全性。2015年5月至2016年12月,共有127例急性缺血性卒中(AIS)患者在本中心接受血管内治疗。其中,5例AIS是由“S”形颈动脉急性夹层所致。所有5例患者均合并颈动脉栓塞,均首先成功接受了基于Solitaire AB支架的栓塞物取出术。随后所有患者均接受了Solitaire AB支架置入术以重新开通闭塞的颈动脉,所有病例均成功再通。除1例患者出现轻微出血转化外,无手术相关并发症。入院时及支架置入后90天的美国国立卫生研究院卒中量表(NIHSS)平均评分分别为12±3.7和3.8±3.4(P = 0.018)。90天时改良Rankin量表评分中位数为2.0±1.4。随访计算机断层扫描血管造影显示,5例患者中有4例支架内通畅。“S”形颈动脉夹层很少导致AIS。通过这种支架置入术可安全可靠地修复此类夹层动脉,确保成功重建颈动脉循环。

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