静脉溶栓桥接Solitaire支架取栓治疗急性后循环梗死并文献复习

doi:10.3877/cma.j.issn.2095-655X.2018.02.016

目的

探讨静脉溶栓桥接Solitaire AB支架取栓治疗急性后循环梗死的效果及安全性。

方法

回顾性分析2017年8至9月聊城市人民医院神经内科采用桥接模式接受血管内治疗的急性后循环梗死患者3例资料，均为基底动脉闭塞，分析血管开通情况、并发症情况、神经功能改善情况、随访3个月时改良Rankin量表评分(mRS)和Barthel指数(BI)评分情况。

结果

3例静脉溶栓桥接Solitaire AB支架取栓均成功再通，第1例静脉溶栓症状好转，4 h后症状加重并进入昏迷，考虑血管再闭塞，紧急启动机械取栓，术后第1天患者清醒；另2例患者静脉溶栓同时联合机械取栓，术后5～7 d复查颅脑CT及CT血管造影(CTA)均显示基底动脉通畅，未见梗死灶扩大，未发生症状性颅内出血(SICH)。3例患者出院时美国国立卫生研究院卒中量表(NIHSS)评分较入院时降低16～27分，出院时mRS评分为3分1例，2分2例；3个月后mRS评分为2分1例，1分2例，BI评分均为95～100分。

结论

颅内大血管闭塞患者可选择静脉溶栓桥接Solitaire AB支架取栓治疗，可提高血管再通率，有效改善预后。

关键词: 静脉溶栓, Solitaire支架, 后循环梗死, 基底动脉

Objective

To explor the safety and effectiveness of intraveneous thrombolysis bridged endovascular thrombectomy with the Solitaire stent retriever for acute posterior circulation ischemia.

Methods

Three patients undergoing bridged endovascular thrombectomy after acute basilar artery thrombosis in the Liaocheng People′s Hospital from August to September 2017 were analyzed retrospectively. The obstructed arteries were basal artery. The primary outcomes included reperfusion immediately, complications and neurologic improvement. Secondary outcomes were the functional scores on the modified Rankin scale (mRS) and Barther index (BI) after 90 days.

Results

The basilar artery thrombosis of the 3 patients were revascularized after intraveneous thrombolysis bridged endovascular thrombectomy. The first patient′s condition improved at one time, then aggravated again after four hours presenting with coma and vascular occlusion, after mechanical thrombectomy in emergency, the patient was conscious in the next morning. The other two patients underwent intravenous thrombolysis and mechanical thrombectomy simultaneously. Three paients were reexamined by brain CT and CT angiography 5 to 7 days after procedure. There were no significant expansion of cerebral infarction and symptomatic intracranial hemorrhage(SICH). The NIHSS scores were 16-27 points lower than those at admission in 3 patients. The mRS scores in 3 patients were 3(1 patient), 2(2 patients) point at discharge. Three months after discharge, the mRS scores were 2 (1 patients), 1(2 patients) point, and the barher index(BI)scores were 95-100 points.

Conclusions

Intravenous thrombolysis bridged early thrombectomy with the Solitaire stent retriever improve revascularization, early neurologic recovery, and functional outcome.

Key words: Intraveneous thrombolysis, Solitaire stent, Posterior circulation ischemia, Basilar aitery

表1 3例急性后循环梗死患者入院时临床特征

病例	临床主诉	体格检查	CT检查	颅脑CTA检查	NIHSS评分(分)
例1	意识不清	浅昏迷，双侧瞳孔等大等圆，光反应灵敏，压眶见右侧肢体可屈曲，左侧肢体无活动，四肢肌张力高，双侧Babinski sign(＋), Chaddock sign(＋)	正常	基底动脉闭塞	25
例2	右侧肢体活动不灵伴言语不清	神志恍惚，构音障碍，压眶左侧肢体定位，右侧肢体屈曲，四肢肢体肌张力高，双侧Babinski sign(＋)，Chaddock sign(＋)	陈旧性脑梗死	基底动脉闭塞	19
例3	意识不清	中度昏迷，双侧瞳孔等大等圆，光反应迟钝，压眶病人无呻吟、无睁眼、四肢伸直、四肢肌张力高，双侧Babinski sign(＋)，Chaddock sign(＋)	正常	基底动脉闭塞	31

表1 3例急性后循环梗死患者入院时临床特征

病例	临床主诉	体格检查	CT检查	颅脑CTA检查	NIHSS评分(分)
例1	意识不清	浅昏迷，双侧瞳孔等大等圆，光反应灵敏，压眶见右侧肢体可屈曲，左侧肢体无活动，四肢肌张力高，双侧Babinski sign(＋), Chaddock sign(＋)	正常	基底动脉闭塞	25
例2	右侧肢体活动不灵伴言语不清	神志恍惚，构音障碍，压眶左侧肢体定位，右侧肢体屈曲，四肢肢体肌张力高，双侧Babinski sign(＋)，Chaddock sign(＋)	陈旧性脑梗死	基底动脉闭塞	19
例3	意识不清	中度昏迷，双侧瞳孔等大等圆，光反应迟钝，压眶病人无呻吟、无睁眼、四肢伸直、四肢肌张力高，双侧Babinski sign(＋)，Chaddock sign(＋)	正常	基底动脉闭塞	31

图1 急性后循环梗死患者静脉溶栓桥接Solitaire支架取栓治疗影像学检查图像

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Report and literature review of the Solitaire stent retriever in treatment of acute posterior circulation ischemia

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Report and literature review of the Solitaire stent retriever in treatment of acute posterior circulation ischemia