大脑中动脉M2段急性闭塞机械取栓疗效分析

  目的  探讨大脑中动脉M2段急性闭塞机械取栓治疗的疗效和安全性。  方法  回顾性收集2019年9月—2020年10月中国科学技术大学附属第一医院大脑中动脉M2段闭塞进行机械取栓的急性脑梗死患者20例。患者中男性8例，女性12例；年龄为32~84(62.5±14.4)岁；入院时美国国立卫生研究院卒中量表(NIHSS)评分(14±3)分；术前ASPECTS评分为8.0(7.0，9.0)分；病因分型采用TOAST分型，其中大动脉粥样硬化型2例，心源性栓塞10例，其他原因5例，不明原因3例；机械取栓前静脉溶栓6例，其中5例使用重组组织型纤溶酶原激活剂，1例使用尿激酶；优势M2患者14例；分析其手术方式、血管再通、颅内出血情况，并分析术后90 d预后。mTICI分级2b~3级为血管成功再通；mRS评分0~2分为临床预后良好。  结果  20例患者平均发病到股动脉穿刺时间为200~582 min，中位时间为370(277，483)min，发病到再通时间为(481.3±121.4)min；6例患者仅使用支架取栓，8例患者仅使用直接抽吸取栓，6例患者使用支架联合抽吸技术取栓，取栓次数为2(1，2)次；成功再通率为95.0%(19/20)，4例患者发生颅内出血，其中2例为症状性颅内出血。90 d随访，20例患者中死亡1例，预后良好患者13例(65.0%)。单因素分析显示，联合静脉溶栓、不合并sICH与90 d良好预后相关。  结论  对大脑中动脉M2段闭塞急性缺血性卒中患者行机械取栓治疗具有安全性和有效性，联合静脉溶栓、不合并sICH与90 d良好预后相关。 

Therapeutic effect analysis of mechanical thrombectomy for acute middle cerebral artery M2 segment occlusion

  Objective  To explore the efficacy and safety of mechanical thrombectomy for acute occlusion of the M2 segment of the middle cerebral artery.  Methods  Twenty patients with acute cerebral infarction who were subjected to mechanical thrombectomy for M2 segment middle cerebral artery occlusion in the First Affiliated Hospital of the University of Science and Technology of China from September 2019 to October 2020 were retrospectively collected. Amongst them, 8 were males, and 12 were females. Their ages ranged from 32 to 84 (62.5±14.4) years. The National Institutes of Health Stroke Scale score was (14±3) on admission. The preoperative ASPECTS score was 8.0 (7.0, 9.0) points. The aetiology classification adopted was TOAST classification, including 2 cases of aortic atherosclerosis, 10 cases of cardiogenic embolism, 5 cases of other causes, 3 cases of unknown cause. Before mechanical thrombectomy, intravenous thrombolysis was performed in 6 cases, of which 5 cases were treated with recombinant tissue plasminogen activator and 1 case with urokinase. There were 14 patients with dominant M2. The operation mode, recanalization and intracranial hemorrhage were analyzed, and the prognosis 90 days after operation was analyzed. An mTICI grade 2b-3 indicated successful recanalisation of blood vessels, and an mRS score of 0-2 meant good clinical prognosis.  Results  The average time from onset to femoral artery puncture in 20 patients was 200-582 min, the median time was 370 (277, 483) min, and the time from onset to recanalisation was (481.3±121.4) min. Stents were only used in 6 patients to remove the thrombus, direct aspiration was only used in 8 patients to remove the embolus, and stent combined with aspiration technology was used in 6 patients to remove the embolus. The number of emboli removed was 2 (1, 2). The successful recanalisation rate was 95%. Four patients had intracranial haemorrhage, and two of them had symptomatic intracranial haemorrhage. At 90-day follow-up, 1 patient died, the good prognosis rate was 65%. Univariate analysis showed that combined intravenous thrombolysis, without sICH were associated with good 90-day prognosis.  Conclusion  Mechanical thrombectomy for acute ischemic stroke patients with middle cerebral artery M2 occlusion is safe and effective. Combined intravenous thrombolysis, without sICH are associated with good prognosis at 90 days.