Zhou Bing, Wang Xiao-Chuan, Xiang Jun-Yi, Zhang Ming-Zhao, Li Bo, Jiang Hai-Bo, Lu Xiao-Dong
Departments of1Interventional and Vascular Surgery, and.
2Neurology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou City, Zhejiang Province, China.
J Neurosurg Pediatr. 2019 Mar 1;23(3):363-368. doi: 10.3171/2018.9.PEDS18242. Epub 2019 Jan 4.
OBJECTIVE Mechanical thrombectomy using a Solitaire stent retriever has been widely applied as a safe and effective method in adult acute ischemic stroke (AIS). However, due to the lack of data, the safety and effectiveness of mechanical thrombectomy using a Solitaire stent in pediatric AIS has not yet been verified. The purpose of this study was to explore the safety and effectiveness of mechanical thrombectomy using a Solitaire stent retriever for pediatric AIS. METHODS Between January 2012 and December 2017, 7 cases of pediatric AIS were treated via mechanical thrombectomy using a Solitaire stent retriever. The clinical practice, imaging, and follow-up results were reviewed, and the data were summarized and analyzed. RESULTS The ages of the 7 patients ranged from 7 to 14 years with an average age of 11.1 years. The preoperative National Institutes of Health Stroke Scale (NIHSS) scores ranged from 9 to 22 with an average of 15.4 points. A Solitaire stent retriever was used in all patients, averaging 1.7 applications of thrombectomy and combined balloon dilation in 2 cases. Grade 3 on the modified Thrombolysis In Cerebral Infarction scale of recanalization was achieved in 5 cases and grade 2b in 2 cases. Six patients improved and 1 patient died after thrombectomy. The average NIHSS score of the 6 cases was 3.67 at discharge. The average modified Rankin Scale score was 1 at the 3-month follow-up. Subarachnoid hemorrhage after thrombectomy occurred in 1 case and that patient died 3 days postoperatively. CONCLUSIONS This study shows that mechanical thrombectomy using a Solitaire stent retriever has a high recanalization rate and excellent clinical prognosis in pediatric AIS. The safety of mechanical thrombectomy in pediatric AIS requires more clinical trials for confirmation. ABBREVIATIONS ACA = anterior cerebral artery; AIS = acute ischemic stroke; CTA = CT angiography; ICA = internal carotid artery; MCA = middle cerebral artery; mRS = modified Rankin Scale; mTICI = modified Thrombolysis In Cerebral Infarction; NIHSS = National Institutes of Health Stroke Scale; rt-PA = recombinant tissue plasminogen activator.
目的 使用Solitaire支架取栓器进行机械取栓已作为一种安全有效的方法在成人急性缺血性卒中（AIS）中广泛应用。然而，由于缺乏数据，使用Solitaire支架进行机械取栓在儿童AIS中的安全性和有效性尚未得到证实。本研究的目的是探讨使用Solitaire支架取栓器对儿童AIS进行机械取栓的安全性和有效性。方法 2012年1月至2017年12月期间，7例儿童AIS患者通过使用Solitaire支架取栓器进行机械取栓治疗。回顾临床实践、影像学及随访结果，并对数据进行总结和分析。结果 7例患者年龄为7至14岁，平均年龄11.1岁。术前美国国立卫生研究院卒中量表（NIHSS）评分9至22分，平均15.4分。所有患者均使用Solitaire支架取栓器，平均取栓1.7次，2例联合球囊扩张。5例患者脑梗死溶栓改良分级（mTICI）达到3级，2例达到2b级。6例患者取栓后病情改善，1例死亡。6例患者出院时NIHSS评分平均为3.67分。3个月随访时改良Rankin量表（mRS）评分平均为1分。取栓后1例发生蛛网膜下腔出血，该患者术后3天死亡。结论 本研究表明，使用Solitaire支架取栓器进行机械取栓在儿童AIS中具有较高的再通率和良好的临床预后。儿童AIS机械取栓的安全性需要更多临床试验证实。缩写词 ACA = 大脑前动脉；AIS = 急性缺血性卒中；CTA = CT血管造影；ICA = 颈内动脉；MCA = 大脑中动脉；mRS = 改良Rankin量表；mTICI = 脑梗死溶栓改良分级；NIHSS = 美国国立卫生研究院卒中量表；rt-PA = 重组组织型纤溶酶原激活剂
