醒后卒中患者的临床诊断学特征及支架取栓技术的临床应用

目的探讨醒后卒中患者的临床诊断学特征及支架取栓治疗的安全性和可行性。 方法选取长治市人民医院神经内科2017年10月至2018年4月收治的3例醒后卒中患者支架取栓治疗的临床资料，分析患者的临床诊断学特征和支架取栓术后血管开通情况、并发症、神经功能改善情况，评估术后90 d时改良Rankin量表评分和Barthel指数评分情况。 结果3例醒后卒中患者均经磁共振血管成像(MRA)证实为颅内前循环大血管闭塞，2例为心源性脑梗死，1例为大动脉粥样硬化性脑梗死，发病时均有意识障碍，美国国立卫生研究院卒中量表评分为13～25分。支架取栓术中闭塞血管均成功再通，脑梗死溶栓血流分级评分≥2b级，术后复查头颅CT未发生颅内出血，梗死灶无扩大，术后30 d时美国国立卫生研究院卒中量表评分较入院时降低10～20分。术后90 d时改良Rankin量表评分1例为3分，2例为2分；Barthel指数评分1例为80分，2例为95分。 结论支架取栓治疗醒后卒中患者有较高的血管再通率，可显著改善患者的临床预后。

Clinical diagnosis characteristics and clinical application of stent thrombectomy in patients with wake-up stroke

ObjectiveTo explore the clinical diagnosis characteristics, the safety and feasibility of stenting thrombectomy technique in patients with wake-up stroke. MethodsClinical data of three patients with wake-up stroke who underwent stent thrombectomy in the Department of Neurology, Changzhi People′s Hospital from October 2017 to April 2018 were collected. Clinical features of patients and their vascular reperfusion, complications and neurologic improvement after stent thrombectomy were analyzed and the functional scores of the modified Rankin scale (mRS) and Barther index (BI) after 90 days of operation were evaluated. ResultsOf the 3 cases, 2 patients were cardiogenic infarction, 1 was atherosclerotic infarction, and all had conscious disorder. NIHSS scores were 13-25, all of them were anterior circulation large vessel occlusion. The occluded vessels were successfully recanalized and cerebral infarction thrombolysis grading system (TICI) score≥2b. There were no intracranial hemorrhage by the brain CT reexamination after operation, and with no significant expansion of cerebral infarction at the same time. 30 days after operation, the NIHSS scores (10-20 points) were lower than those at admission. The postoperative mRS score was 3 points in 1 case and 2 points in the other 2 cases and the BI score was 80 points in 1 case and 95 points in the other 2 cases after 90 days of operation. ConclusionStent thrombectomy has a high vascular recanalization rate in patients with wake-up stroke, and can significantly improve the clinical prognosis of patients.