孤立性近端后动脉闭塞所致急性缺血性卒中的血管内治疗
Endovascular Treatment of Acute Ischemic Stroke Due to Isolated Proximal Posterior Artery Occlusion.
作者信息
Zhang Guang, Zhu Yujing, Ling Yeping, Chen Pingbo, Dai Jiaxing, Wang Chunlei, Xu Shancai, Shumadalova Alina, Shi Huaizhang
机构信息
Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
Department of General Chemistry, Bashkir State Medical University, Ufa, Republic of Bashkortostan, Russia.
出版信息
Front Surg. 2022 May 25;9:919509. doi: 10.3389/fsurg.2022.919509. eCollection 2022.
BACKGROUND
Acute ischemic stroke (AIS) due to isolated proximal posterior cerebral artery (PPCA) occlusion is rare but associated with high morbidity and mortality rates. However, the optimal treatment strategy for patients with AIS caused by PPCA remains unclear. We discuss our single-center experience with endovascular treatment (EVT) in patients with PPCA.
METHODS
Data from patients with AIS due to PPCA occlusion were retrospectively analyzed. We analyzed procedural details, the degree of reperfusion, functional outcomes, and complications. Functional outcomes were determined using the modified Rankin Scale (mRS) at 90 days, and good outcome was defined as mRS 0-2 at 90 days. Successful reperfusion was defined as modified treatment in cerebral ischemia (mTICI) 2b-3 after endovascular therapy. Safety variables included symptomatic hemorrhage (defined as an increase of four or more points in the National Institute of Health Stroke Scale score), vessel perforation or dissection, and new ischemic stroke in different territories.
RESULTS
Seven patients were included in this study. The mean age of the patients was 64 ± 12.4 years. Successful reperfusion was achieved in all seven patients (100%). Good outcomes were achieved at 90 days in 2 patients (28.6%), and favorable outcomes were observed in five patients (71.4%). One patient underwent angioplasty as rescue therapy after three attempts. One patient died because of severe gastrointestinal bleeding 24 h after EVT, which was probably a complication of intravenous alteplase. One patient had an embolism in the basilar artery and achieved complete reperfusion after rescue thrombectomy. Another patient had a complication of vessel dissection in the PPCA and underwent stent implantation as rescue therapy. We observed no recurrence of ischemic stroke or any intracranial hemorrhage on non-contrast computed tomography 24 h after the procedure.
CONCLUSION
EVT may represent an alternative treatment strategy for patients with acute ischemic stroke caused by PPCA.
背景
孤立性大脑后动脉近端（PPCA）闭塞所致的急性缺血性卒中（AIS）较为罕见，但发病率和死亡率较高。然而，PPCA导致的AIS患者的最佳治疗策略仍不明确。我们讨论了我们在PPCA患者中进行血管内治疗（EVT）的单中心经验。
方法
对PPCA闭塞所致AIS患者的数据进行回顾性分析。我们分析了手术细节、再灌注程度、功能结局和并发症。使用改良Rankin量表（mRS）在90天时确定功能结局，良好结局定义为90天时mRS为0 - 2。成功再灌注定义为血管内治疗后改良脑缺血治疗（mTICI）2b - 3级。安全变量包括症状性出血（定义为美国国立卫生研究院卒中量表评分增加4分或更多）、血管穿孔或夹层以及不同区域的新发缺血性卒中。
结果
本研究纳入7例患者。患者的平均年龄为64±12.4岁。所有7例患者（100%）均实现了成功再灌注。2例患者（28.6%）在90天时获得良好结局，5例患者（71.4%）观察到有利结局。1例患者在三次尝试后接受血管成形术作为挽救治疗。1例患者在EVT后24小时因严重胃肠道出血死亡，这可能是静脉注射阿替普酶的并发症。1例患者基底动脉发生栓塞，在挽救性血栓切除术后实现完全再灌注。另1例患者PPCA出现血管夹层并发症，接受支架植入作为挽救治疗。术后24小时非增强计算机断层扫描未观察到缺血性卒中复发或任何颅内出血。
结论
EVT可能是PPCA所致急性缺血性卒中患者的一种替代治疗策略。
Zotero 插件