Li He, Li Zifu, Hua Weilong, Zhang Yongxin, Yang Wenjin, Feng Mingtao, Zhang Lei, Xing Pengfei, Zhang Yongwei, Hong Bo, Yang Pengfei, Liu Jianmin
Stroke Center, Changhai Hospital, Navy Medical University, Shanghai, China.
Graduate School, Navy Medical University, Shanghai, China.
Chin Neurosurg J. 2021 Jan 11;7(1):7. doi: 10.1186/s41016-020-00221-1.
Previous studies indicated the effectiveness of permanent stenting when dealing with retriever-failed refractory large vascular occlusion (LVO). Variety types of stents were implanted permanently to achieve recanalization. Low-profile visualized intraluminal support (LVIS) is generally used as a supportive device for embolization of intracranial aneurysm. Its specific structural and functional characteristics contribute to its potential of treating LVO.
A 51-year-old male was transferred to our stroke center because of conscious disturbance with the weakness of the left upper limb. The National Institute of Health Stroke Scale (NIHSS) was 24; the Glasgow Coma Scale (GCS) was 10. Digital subtraction angiography (DSA) showed that his paraclinoid segment of R-ICA was occluded due to hard clot embolization. Thrombectomy was performed 6 times, but the occlusion remained. Finally, LVIS was implanted permanently and post-dilation was performed, which successfully recanalized the artery (eTICI 2c). The post-operative NIHSS and GCS were 20 and 11, respectively, which were 10 and 14 when discharged. Another patient was a 71-year-old male who suffered weakness of left limbs. NIHSS was 15; GCS was 11. DSA confirmed that the paraclinoid segment of his R-ICA was occluded due to hard clot embolization. Totally 6 times of mechanical thrombectomy, angioplasty, and tirofiban infusion were performed, which failed to recanalize the artery. In the end, LVIS implantation with post-dilation was performed, and full recanalization was achieved (mTICI 3). The post-operative NIHSS and GCS were 9 and 15, respectively, which were 3 and 15 when discharged.
These 2 cases invited LVIS into the treatment of refractory occlusion due to hard clot embolization at the paraclinoid segment, and the outcomes were preferable because of the higher visibility, higher flexibility, and lower cell size of LVIS.
先前的研究表明，在处理取栓失败的难治性大血管闭塞（LVO）时，永久性支架置入术是有效的。已植入各种类型的永久性支架以实现再通。低轮廓可视化腔内支撑装置（LVIS）通常用作颅内动脉瘤栓塞的支撑装置。其特定的结构和功能特性有助于其治疗LVO的潜力。
一名51岁男性因意识障碍伴左上肢无力被转至我院卒中中心。美国国立卫生研究院卒中量表（NIHSS）评分为24分；格拉斯哥昏迷量表（GCS）评分为10分。数字减影血管造影（DSA）显示，其右侧颈内动脉床突旁段因硬血栓栓塞而闭塞。进行了6次取栓，但闭塞仍存在。最后，永久性植入LVIS并进行球囊后扩张，成功使动脉再通（脑梗死溶栓分级（eTICI）2c级）。术后NIHSS和GCS评分分别为20分和11分，出院时分别为10分和14分。另一例患者为71岁男性，有左下肢无力症状。NIHSS评分为15分；GCS评分为11分。DSA证实其右侧颈内动脉床突旁段因硬血栓栓塞而闭塞。总共进行了6次机械取栓、血管成形术和替罗非班输注，但未能使动脉再通。最后，进行LVIS植入并球囊后扩张，实现了完全再通（改良脑梗死溶栓分级（mTICI）3级）。术后NIHSS和GCS评分分别为9分和15分，出院时分别为3分和15分。
这2例患者采用LVIS治疗床突旁段硬血栓栓塞所致难治性闭塞，由于LVIS具有更高的可视性､更高的柔韧性和更小的网孔尺寸，治疗效果较好。
