Wang Xi-Feng, Wang Ming, Li Gang, Xu Xue-Yu, Shen Wei, Liu Jing, Xiao Shuang-Shuang, Zhou Jiang-Hong
Department of Neurology, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, Hubei Province, China.
World J Clin Cases. 2021 Jul 6;9(19):5028-5036. doi: 10.12998/wjcc.v9.i19.5028.
In both national and international studies, the safety and effectiveness of treatment with the Solitaire stent in patients with ischemic stroke caused by acute large vessel occlusion were good, and the disability rate was significantly reduced. However, there are currently only a few reports on the differences in endovascular treatment for different etiological classifications, especially in the anterior cranial circulation, aorta atherosclerotic stenosis, and acute thrombosis.
To investigate the efficacy of Solitaire AB stent-release angioplasty in patients with acute middle cerebral artery atherosclerosis obliterative cerebral infarction.
Twenty-five patients with acute middle cerebral atherosclerosis obliterative cerebral infarction were retrospectively enrolled in this study from January 2017 to December 2019. The Solitaire AB stent was used to improve anterior blood flow to maintain modified cerebral infarction thrombolysis [modified thrombolysis in cerebral infarction (mTICI)] at the 2b/3 level or above, the stent was then unfolded and released.
All 25 patients underwent successful surgery, with an average recanalization time of 23 min. One patient died of cerebral hemorrhage and cerebral herniation after the operation. The National Institutes of Health Stroke Scale (NIHSS) scores immediately after surgery (7.5 ± 5.6), at 24 h (5.5 ± 5.6) and at 1 wk (3.6 ± 6.7) compared with the preoperative NIHSS score (15.9 ± 4.4), were significantly different ( < 0.01). One case of restenosis was observed 3 mo after surgery (the stenosis rate was 50% without clinical symptoms), the modified Rankin scale scores were 0 points in 14 cases (56%), 1 point in 4 cases (16%), 2 points in 2 cases (8%), 3 points in 3 cases (12%), 4 points in 1 case (4%), and 6 points in 1 case (4%).
In acute middle cerebral artery atherosclerosis obliterative cerebral infarction, when the Solitaire AB stent is unfolded and the forward blood flow is maintained at mTICI level 2b/3 or higher, stent release may be a safe and effective treatment method; however, long-term observation and a larger sample size are required to verify these findings.
在国内和国际研究中，Solitaire支架治疗急性大血管闭塞所致缺血性卒中患者的安全性和有效性良好，致残率显著降低。然而，目前关于不同病因分类的血管内治疗差异的报道较少，尤其是在前循环、主动脉粥样硬化狭窄和急性血栓形成方面。
探讨Solitaire AB支架释放血管成形术治疗急性大脑中动脉粥样硬化闭塞性脑梗死患者的疗效。
回顾性纳入2017年1月至2019年12月期间25例急性大脑中动脉粥样硬化闭塞性脑梗死患者。使用Solitaire AB支架改善前向血流，以维持改良脑梗死溶栓（modified thrombolysis in cerebral infarction，mTICI）2b/3级或以上，然后展开并释放支架。
25例患者均手术成功，平均再通时间为23分钟。1例患者术后死于脑出血和脑疝。术后即刻（7.5±5.6）、术后24小时（5.5±5.6）和术后1周（3.6±6.7）的美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分与术前NIHSS评分（15.9±4.4）相比，差异有统计学意义（<0.01）。术后3个月观察到1例再狭窄（狭窄率为50%，无临床症状），改良Rankin量表评分为0分者14例（56%），1分者4例（16%），2分者2例（8%），3分者3例（12%），4分者1例（4%），6分者1例（4%）。
在急性大脑中动脉粥样硬化闭塞性脑梗死中，当展开Solitaire AB支架并将前向血流维持在mTICI 2b/3级或更高水平时，支架释放可能是一种安全有效的治疗方法；然而，需要长期观察和更大样本量来验证这些发现。
