血管内再通术治疗症状性慢性大脑中动脉闭塞的初步临床观察

目的初步观察血管内再通术治疗症状性慢性大脑中动脉闭塞的临床疗效。方法纳入24例2019年1—12月郑州大学人民医院脑血管介入治疗中心采用血管内再通术治疗的症状性慢性大脑中动脉闭塞患者,回顾性观察血管再通的成功率、围手术期并发症的发生率及短期随访结果。结果24例患者中,20例(83.3%)血管成功再通,其中脑梗死溶栓治疗分级(TICI)2b级者6例,3级者14例;4例(16.7%)血管再通失败。共6例(25.0%)发生手术相关并发症。其中20例血管再通成功的患者中,发生蛛网膜下腔出血2例,高灌注脑出血1例,3例患者均行保守治疗,术后2周内出血均吸收,未遗留神经功能缺损症状;1例患者血管再通成功后突发心脏骤停死亡。4例血管再通失败的患者中,血管破裂1例,血管夹层1例。23例患者的术后随访时间为(5.0±1.3)个月(3~6个月)。20例血管再通成功的患者中,2例蛛网膜下腔出血者再通血管再次闭塞,末次随访时临床症状再发;其余患者无缺血症状再发,但影像学证实与术后即刻比较,1例血管狭窄率为42%,4例血管狭窄率≤10%。4例血管再通失败的患者脑缺血症状均再发。结论在严格掌握适应证的情况下,采用血管内再通术治疗症状性慢性大脑中动脉闭塞是可行的,相对安全;在短期内可改善患者的临床症状,但有再闭塞的风险;远期疗效需进一步观察。

Preliminary clinical study of endovascular recanalization for symptomatic chronic middle cerebral artery occlusion

Objective To explore the preliminary clinical outcome of endovascular recanalization for symptomatic chronic middle cerebral artery(MCA)occlusion.Methods From January 2019 to December 2019,24 patients with symptomatic chronic middle cerebral artery(MCA)occlusion were enrolled into this study and underwent endovascular recanalization at Cerebrovascular Division of Inte-rventional Therapy Center,Zhengzhou University People′s Hospital.We retrospectively analyzed the success rate of recanalization,periprocedural complications and clinical follow-up.Results Among 24 patients,recanalization was successful in 20 patients[thrombolysis in cerebral infarction(TICI)grade 2b in 6 patients and 3 grade in 14 patients]and failed in 4 patients.Periprocedural complications occurred in six cases(25.0%).Among the 20 successful patients,periprocedural complications occurred in four cases,including subarachnoid hemorrhage in two cases and hyperperfusion cerebral hemorrhage occurred in one case.Those three patients were treated conservatively whose hematomas were absorbed within 2 weeks after surgery with no remaining neurofunctional deficits.One patient died of sudden cardiac arrest after successful recanalization.Of the 4 patients who failed in recanalization,1 case had vascular rupture and 1 case had vascular dissection.The follow-up time of 23 patients was 5.0±1.3 months(3-6 months).Among the 20 successful patients,the reocclusion occurred in two patients who suffered from subarachnoid hemorrhage and their ischemic symptoms recured at the follow-up.The rest of patients had no recurrence of ischemic symptoms.Imaging results indicated a restenosis of 42%in one patient and stenosis of≤10%in four patients.All 4 failed patients had recurrence of ischemic symptoms.Conclusions With strict indication criteria,endovascular recanalization of symptomatic chronic MCA occlusion is feasible and relatively safe,which could improve the patient's symptoms in the short term,while there is a risk of reocclusion.Further studies are needed to investigate the long-term efficacy.