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[症状性非急性颅内动脉闭塞的血管内再通:单中心病例系列]

[Endovascular recanalization of symptomatic non-acute intracranial arterial occlusion: a single center case series].

作者信息

Wang J J, Qi P, Chen K P, Lu J, Hu S, Yang X M, Wang D M

机构信息

Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2020 Dec 1;58(12):897-903. doi: 10.3760/cma.j.cn112139-20200429-00349.

Abstract

To investigate the feasibility and safety of endovascular recanalization for symptomatic non-acute intracranial arterial occlusion (NAICO). Twenty-five consecutive patients who underwent endovascular recanalization for NAICO between January 2017 and October 2019 at Department of Neurosurgery, Beijing Hospital were retrospectively reviewed.There were 20 males and 5 females, aged (60.5±11.0) years (range: 41 to 73 years).The preoperative modified Rankin score(()) was 2 (2.5)(range: 1 to 5).The occlusion time was 40 (54)days (range: 17 to 570 days).The demographic data were collected. The initial procedural results, including the rate of successful recanalization, periprocedural complications and data pertaining to angiographic and clinical follow-up were recorded. Recanalization was successful in 20 of 27 occlusive lesions of 25 patients. Intraoperative complications occurred in 3 cases, including vascular perforation in 1 case, arterial dissection in 1 case, and perforator occlusion occurred in 1 case. The incidence of permanent complications was 3.7% (1/27). All 25 patients underwent clinical follow-up, with a median period of 8 months (range: 1 to 33 months), and 23 patients with improved or stable modified Rankin scale. One patient developed new ischemic symptoms 2 months after discharge, and 1 patient died of complications of bed rest.The results of the angiography follow-up (median 4 months, range: 2 days to 9 months) showed that reocclusion occurred in 5 of all 20 successfully recanalized patients. Endovascular recanalization for symptomatic NAICO is feasible, relatively safe, and efficacious in highly selected cases. However, further larger scale pilot studies are needed to determine the efficacy and long-term outcome associated with this treatment.

摘要

探讨症状性非急性颅内动脉闭塞(NAICO)血管内再通治疗的可行性和安全性。回顾性分析2017年1月至2019年10月在北京医院神经外科接受NAICO血管内再通治疗的25例连续患者。其中男性20例,女性5例,年龄(60.5±11.0)岁(范围:41至73岁)。术前改良Rankin量表评分为2(2.5)(范围:1至5)。闭塞时间为40(54)天(范围:17至570天)。收集人口统计学数据。记录初始手术结果,包括成功再通率、围手术期并发症以及与血管造影和临床随访相关的数据。25例患者的27个闭塞病变中有20个再通成功。术中并发症发生3例,包括血管穿孔1例、动脉夹层1例、穿支闭塞1例。永久性并发症发生率为3.7%(1/27)。25例患者均接受临床随访,中位随访时间为8个月(范围:1至33个月),23例患者改良Rankin量表评分改善或稳定。1例患者出院后2个月出现新的缺血症状,1例患者死于卧床并发症。血管造影随访结果(中位4个月,范围:2天至9个月)显示,20例成功再通的患者中有5例发生再闭塞。症状性NAICO的血管内再通治疗在高度选择的病例中是可行、相对安全且有效的。然而,需要进一步进行更大规模的前瞻性研究来确定这种治疗方法的疗效和长期预后。

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