支架取栓术治疗合并副大脑中动脉的急性大脑中动脉闭塞1例

副大脑中动脉(accessory middle cerebral artery,AMCA)是指起源于大脑前动脉,行经侧裂并与大脑中动脉(middle cerebral artery,MCA)伴行,参与MCA供血区供血的脑血管变异,文献报道发生率约为0.3％.本文报道1例合并AMCA变异的急性MCA闭塞,通过swim技术...     

动脉粥样硬化性脑梗死和心源性脑梗死机械取栓治疗的比较

目的 探讨动脉粥样硬化性脑梗死(LAA)和心源性脑梗死(CE)机械取栓治疗的差异和疗效。方法 回顾分析2017年6月-2018年8月行机械取栓治疗的脑梗死患者 33 例,比较2组患者的危险因素、闭塞的血管、侧支循环、取栓次数、从股动脉穿刺至血管再通的时间、取栓后补救措施和血管再通的程度,并评估NIHSS评分、mRS评分和术后并发症。结果 CE组的冠心病(或风心病)、房颤病史比例高于LAA组(P<0.05); LAA 组侧支循环良好率为43.48%,高于CE组的10%(P=0.045); CE组从动脉穿刺到血管再通的时间、取栓的次数均P<0.05); 2组患者术前和术后3月的NIHSS评分、mRS评分比较均无明显差异(P>0.05); 2组开通后再闭塞、脑出血和病死率也无统计学差异(P>0.05)。结论 相比动脉粥样硬化性脑梗死,心源性脑梗死患者行取栓治疗需要更短的开通时间、更少的取栓次数、得到更好的血流灌注,但2组最终的预后相似。     

颅内支撑导管联合Solitaire FR取栓支架技术治疗急性大脑中动脉闭塞脑梗死临床观察

目的 分析颅内支撑导管联合Solitaire FR取栓支架(solitaire FR with intracranial support catheter for mechanical thrombectomy,SWIM)技术治疗急性大脑中动脉闭塞脑梗死的安全性、有效性.方法 选取2019-05—2020-05湛江中心...     

直接取栓术治疗急性前循环大血管闭塞41例

目的 探讨直接机械取栓术治疗急性前循环大血管闭塞的有效性.方法 回顾性分析2016年4月至2018年4月机械取栓术治疗的41例急性前循环大血管闭塞的临床资料.使用改良脑梗死溶栓分级(mTICI)评价血管开通效果.发病90 d采用改良Rankin量表(mRS)评分评估预后,0～2分为预后良好.结果 41例中,血管开通达到...     

Solitaire AB支架机械取栓治疗急性颅内动脉闭塞

目的 探讨Solitaire AB支架机械取栓术治疗急性颅内大血管闭塞的疗效。方法 2011年3月至2014年11月收治46例急性颅内动脉闭塞的病人,均采用Solitaire AB支架机械取栓治疗。结果 46例患者取栓手术均取得成功,总再通率91.3%（42/46）;取栓次数为1~4次;取栓时间平均为23 min;术后死亡2例。出院后随访1~3个月,失访1例;改良Rankin量表评分0分31例,1分10例,2分1例,4分1例,6分2例。结论 动脉内机械取栓能大大缩短血管再通时间,最大程度的挽救缺血半暗带脑组织,减轻脑组织损伤,是治疗急颅内动脉闭塞的有效方法。     

大脑中动脉M2段急性闭塞机械取栓临床疗效评估

目的 评估机械取栓应用于大脑中动脉（middle middle cerebral artery,MCA）M2段急性闭塞的有效 性和安全性。 方法 回顾性收集MCA M2段急性闭塞并实施机械取栓患者的临床资料,以90 d mRS评分分为良好 结局（mRS评分0～2分）与不良结局（mRS评分＞2分）组,比较两组基线临床资料、入院NIHSS评分、是 否合并静脉溶栓、闭塞部位、颅内出血（symptomatic intracranial hemorrhage,SICH）、再通时间等资料 的差异。 结果 共入组行机械取栓术的MCA M2段急性闭塞患者12例（男女各6例）。平均年龄（71.4±8.1)岁, 入院NIHSS评分中位数为18分,术后即刻血管再通[改良的脑梗死溶栓（modified thrombolysis in cerebral i nfarcti on,mTI CI ）2b～3级]11例（91.6%）,出血3例（25.0%）,其中SI CH 1例（8.3%）,24 h时血管再通11 例（91.6%）。90 d良好结局组4例,不良结局组8例。良好结局组入院NIHSS评分低于不良结局组（中位 数14分 vs 22分,P =0.038）,两组间其余因素差异无统计学意义。 结论 MCA M2段急性闭塞机械取栓的有效性及安全性有待观察,患者入院时NIHSS评分较低与 90 d预后良好有关。     

内膜斑块剥脱术与支架置入术治疗颈动脉狭窄的Meta分析

目的 探讨颈动脉内膜斑块剥脱术（CEA）与颈动脉支架置入术（CAS）治疗颈动脉狭窄的疗效。方法 计算机检索Pubmed、Embase数据库,收集CEA与CAS治疗颈动脉狭窄的随机对照研究,应用Stata软件进行统计分析。结果 共纳入12项研究,共7 401例患者。Meta分析结果显示:术后30 d,CAS组卒中和死亡联合事件发生率（OR=1.51,95% CI为1.23~1.84;P<0.001）、任意卒中事件发生率（or ci为1.18~1.83;P<0.001）均明显高于cea组;而心肌梗死发生率（or ci为0.28~0.75;p="0.002）、颅神经损伤发生率（OR=0.08,95%" ci为0.04~0.14;P<0.001）均明显低于cea组。两组致残性卒中和死亡联合事件发生率（or ci为0.93~1.77;p="0.13）、病死率（OR=1.52,95%" ci为0.96~2.41;p="0.07）、致残性卒中发生率（OR=1.16,95%" ci为0.79~1.71;p="0.46）无明显差异。结论 CAS治疗颈动脉狭窄短期安全性和有效性与CEA类似。     

急性颅内大动脉粥样硬化与栓塞性缺血脑卒中机械取栓治疗的对比研究

目的 对比分析血管内机械取栓治疗颅内大动脉粥样硬化性(ICAS)和栓塞性(embolic)急性缺血性脑卒中的临床效果和安全性。方法 回顾性分析2019-01—2021-12采用血管内机械取栓治疗的118例急性大血管闭塞的缺血性脑卒中患者的临床资料,其中ICAS组27例(22.9%),Embolic组91例(77.1%)。结果 与Embolic组比较,ICAS组更高的后循环闭塞比例(37.0%vs 14.3%,P=0.009)、更高的球囊扩张(66.7%vs 7.7%,P<0.001)及支架置入比例(59.3%vs 6.6%,P<0.001),手术时间明显延长[110.00(80.00～130.00)min vs 85.00(55.00～120.00)min,P=0.021)],年龄更小[(63.67±11.48)岁vs(68.25±10.13)岁,P=0.047],合并冠心病比例(14.8%vs 41.8%,P=0.010)、心房颤动比例(7.4%vs 52.7%,P<0.001)及术后出血发生率(3.7%vs 23.1%,P=0.023)明显降低,2组血管成功再通率...     

动脉粥样硬化性大脑中动脉狭窄梗死的发病机制

现代影像学的发展包括数字减影血管造影(DSA)、经颅多普勒超声(TCD)、核磁血管成像(MRA)、核磁共振(MRI)、弥散加权核磁共振(DWI)和微栓子(MES)监测，为检查颅内血管狭窄及研究其导致脑梗死的可能发病机制提供了方法。我们总结了香港中文大学威尔斯亲王医院和中国医学科学院北京协和医院在近10年中应用上述现代影像     

Number of Stent Retriever Passes Associated with Clinical Outcome After Mechanical Thrombectomy in Acute Ischemic Stroke

ObjectiveTo evaluate the association between the number of stent retriever (SR) passes and clinical outcome after mechanical thrombectomy (MT) in patients with acute ischemic stroke(AIS).MethodsWe retrospectively analyze data collected from consecutive patients with large vessel occlusion (LVO) in anterior circulation treated with MT. Baseline characteristics, number of SR passes, symptomatic intracranial hemorrhage (sICH), clinical outcome measured by modified Rankin Scale (mRS) at 90 days after MT were collected. Multivariate logistic regression analysis was performed to assess the association between number of SR passes and patients’ clinical outcome.Results134 patients with LVO achieved successful reperfusion (mTICI 2B/3) were enrolled. Univariate analysis showed that patients with favorable outcomes were less likely to need more than three passes of SR (9.8%vs39.7%, p = 0.001). In a multivariable analysis, baseline NIHSS score (OR 0.922, 95%CI 0.859∼0.990, p = 0.025), more than three passes of SR (OR 0.284, 95%CI0.091∼0.882, p = 0.030) and symptomatic intracranial hemorrhage (OR 0.116,95%CI0.021∼0.650, p = 0.014) each independently predicted poor outcome after MT at 90 days.ConclusionThe need for more than three passes of SR may be used as an independent predictor of poor outcome after MT in patients with acute ischemic stroke at 90 days.     

Direct Aspiration versus Stent Retriever Thrombectomy for Acute Stroke: A Systematic Review and Meta-Analysis in 9127 Patients

Background: The two most common approaches to thrombectomy of emergent large vessel occlusion (direct aspiration and primary stent retriever thrombectomy) have been extensively studied; however, the detailed benefit and risk comparison is largely unknown. Objective: To conduct a systematic review and meta-analysis to compare radiographic and clinical outcomes between the use of primary stent retrievers and direct aspiration in management of acute ischemic stroke. Methods: PubMed database was searched for studies between September 1, 2012 and December 31, 2017 with acute ischemic stroke patients. Results: We identified 64 studies with 6875 patients in the primary stent retriever group and 25 studies with 2252 patients in the aspiration group. Primary aspiration alone, without the need of rescue stent retriever devices within the aspiration cohort, was performed in 65% of 2252 patients. There was no difference in the distribution of emergent large vessel occlusion based on occlusion site, age, baseline National Institutes of Health Stroke Scale, or the use of intravenous tPA (P?=?.19, .051, .23, and .093, respectively). Successful recanalization rates, defined as thrombolysis in cerebral Infarction 2b/3, were significantly higher in the aspiration group than the primary stent retriever group (89% versus 80%, P < .0001). No significant difference in good clinical outcome, defined as modified Rankin scale 0-2 (aspiration 52% versus stent 48%, P?=?.13), symptomatic intracerebral hemorrhage (aspiration 5.6% versus stent 7.2%, P?=?.07), and mortality at 3 months (aspiration 15% versus stent 19%, P?=?.10). Conclusions: Both aspiration-first (including the subsequent use of stent retriever) and primary stent retriever thrombectomy approaches are equally effective in achieving good clinical outcomes. Our study suggests that direct aspiration with or without subsequent use of stent retriever is a safe and effective alternative to primary stent retriever in acute ischemic stroke.     

Effectiveness of Anchoring with Balloon Guide Catheter and Stent Retriever in Difficult Mechanical Thrombectomy for Large Vessel Occlusion

ObjectiveA distal navigation of a large bore aspiration catheter during mechanical thrombectomy (MT) is important. However, delivering a large bore aspiration catheter is difficult to a tortuous or atherosclerotic artery. We report the experience of anchoring with balloon guide catheter (BGC) and stent retriever to facilitate the passage of an aspiration catheter in MT. MethodsWhen navigating an aspiration catheter failed with a conventional co-axial microcatheter delivery, an anchoring technique was used. Two types of anchoring technique were applied to facilitate distal navigation of a large bore aspiration catheter during MT. First, a passage of aspiration catheter was attempted with a proximal BGC anchoring technique. If this technique also failed, another anchoring technique with distal stent retriever was tried. Consecutive patients who underwent MT with an anchoring technique were identified. Details of procedure, radiologic outcomes, and safety variables were evaluated. ResultsA total of 67 patients underwent MT with an anchoring technique. Initial trial of aspiration catheter passage with proximal BGC anchoring technique was successful for 35 patients (52.2%) and the second trial with distal stent retriever anchoring was successful for 32 patients (47.8%). Overall, navigation of a large bore aspiration catheter was successful for all patients (100%) without any procedure related complications. ConclusionOur study showed the usefulness of anchoring technique with proximal BGC and distal stent retriever during MT, especially in those with an unfavorable anatomical structure. This technique could be an alternative option for delivering an of aspiration catheter to a distal location.     

Mechanical Thrombectomy in Stroke from Infective Endocarditis: Case Report and Review

ObjectiveTo characterize outcomes after mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) from infective endocarditis.MethodsCase report and review of published cases.ResultsWe report the case of a 59-year-old woman with fungal endocarditis who developed AIS from a proximal middle cerebral artery (MCA) embolus. She underwent MT, with good outcome. An additional 25 similar cases were identified from 14 publications. Among the 26 cases analyzed (mean [SD] age, 55 [18.7] years, 42% women), the MCA was the most common site of arterial occlusion. Four patients received intravenous tissue plasminogen activator treatment before MT. The median admission NIH Stroke Scale score (NIHSSS) was 15.5 [interquartile range 9.75-19.25] and the median post-procedure NIHSSS was 2 [interquartile range .75-6]. No patient developed symptomatic intracerebral hemorrhage.ConclusionsMT appears to be a safe and effective therapeutic option in infective endocarditis-related AIS with proximal-artery occlusion.     

Inadvertent Self-Detachment of Solitaire AB Stent during the Mechanical Thrombectomy for Recanalization of Acute Ischemic Stroke: Lessons Learned from the Removal of Stent via Surgical Embolectomy

We recently experienced self-detachment of the Solitaire stent during mechanical thrombectomy of acute ischemic stroke. Then, we tried to remove the detached stent and to recanalize the occlusion, but failed with endovascular means. The following diffusion weighted image MRI revealed no significant increase in infarction size, therefore, we performed surgical removal of the stent to rescue the patient and to elucidate the reason why the self-detachment occurred. Based upon the operative findings, the stent grabbed the main thrombi but inadvertently detached at a severely tortuous, acutely angled, and circumferentially calcified segment of the internal carotid artery. Postoperative angiography demonstrated complete recanalization of the internal carotid artery. The patient''s neurological deficits gradually improved, and the modified Rankin scale score was 2 at three months after surgery. In the retrospective case review, bone window images of the baseline computed tomography (CT) scan corresponded to the operative findings. According to this finding, we hypothesized that bone window images of a baseline CT scan can play a role in terms of anticipating difficult stent retrieval before the procedure.     

应用Trevo ProVue支架取栓治疗前循环脑动脉急性闭塞的初步经验

目的探讨应用Trevo ProVue支架对前循环脑动脉急性闭塞进行支架取栓治疗的安全性及有效性。方法回顾本中心13例采用Trevo ProVue支架取栓治疗前循环脑动脉急性闭塞患者的临床资料。应用改良脑梗死溶栓(modified thrombolysis in cerebral infarction,mTICI)分级评估闭塞血管再通情况,比较患者术前及术后24 h美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分。并于术后90 d进行临床随访,采用改良Rankin量表(modified Rankin scale,mRS)评分评估患者独立生活情况。结果 13例患者中,术后即刻8例获得mTICI分级2b～3级再通,4例mTICI分级2a级再通,1例血管无法开通mTICI分级0级。患者入院时NIHSS评分15.0(9.5～21.0)分,术后24 h NIHSS评分7.0(5.5～16.0)分,比较差异具有统计学意义(t=2.38,P=0.035)。90 d临床随访,mRS评分0～2分6例(46.15%),3分2例,4分2例,5分1例,6分(死亡)2例。结论应用Trevo ProVue支架取栓治疗前循环脑动脉急性闭塞是安全、有效的。     

Regionwide Retrospective Survey of Acute Mechanical Thrombectomy in Tama,Suburban Tokyo: A Preliminary Report

Background and Purpose

To improve results of acute thrombectomy, the time from stroke onset to efficient recanalization must be minimized. Studies have confirmed the importance of rapid treatment, workflow, and efficient team-based care for acute thrombectomy in large vessel occlusion. This study examined the challenges facing mechanical thrombectomy in the Tama area (population, 4.3 million), a densely populated urban area of Tokyo, Japan, and analyzed retrospective data from the Tama-REgistry of Acute endovascular Thrombectomy.

Mechanical Thrombectomy for Acute Ischemic Stroke in Pregnancy

Intravenous recombinant tissue-plasminogen-activator (rtPA) and mechanical-thrombectomy (MT) are currently the only approved treatments for acute ischemic stroke. Their effectiveness was demonstrated in several clinical trials, and is therefore standard of care. Pregnant women were not included in these studies and consequently the effectiveness and safety in this group are unclear. We present a rare case of a patient in the third-trimester of pregnancy that underwent MT. A 29-year-old woman of 39 weeks’ gestation presented with left facial-paresis, hemiparesis, and neglect. Her CT-Angiogram showed a large occlusive thrombus within the right M1-M2 segments. During pregnancy she had developed thrombocytopenia. There was initial treatment decision dilemma. In view of her history of thrombocytopenia, there was concern about administering rtPA due to the risk of bleeding. As the thrombus was large, rtPA may also be ineffective. MT was proposed by the Stroke Physician as the preferred treatment option. A concern from the Interventional-Radiologist was the risk of exposure to radiation and contrast agents. As the patient had a disabling stroke at a young age, decision was made to proceed with MT which started 141 minutes after symptom onset. The clot was aspirated without complications. Final check angiogram showed complete resolution of flow within the right middle cerebral artery territory. The patient underwent elective uncomplicated Caesarean-section 5 days later delivering a healthy new born. Severe stroke in pregnancy is rare, but has grave consequences for both mother and infant. Timely decision-making is crucial. Our case demonstrates that MT can be provided safely and effectively in the third trimester of pregnancy.     

T-Configuration Stent Placement for Carotid Bifurcation Stenosis Co-Existing with Ipsilateral Intracranial Stenosis: A Case Report and Literature Review

In patients with carotid bifurcation stenosis co-existing with ipsilateral intracranial artery stenosis, combined treatment with carotid artery stenting (CAS)/carotid endarterectomy (CEA) and extracranial-to- intracranial (EC-IC) bypass can be a useful option to prevent future ischemic stroke events. EC-IC bypass requires a sufficient antegrade flow in the ipsilateral external carotid artery. However, standard CAS/CEA occasionally lead to external carotid artery occlusion. Herein, we present a case of successful one-stage endovascular revascularization of both the antegrade internal and external carotid artery flow using the carotid T-stent technique for carotid bifurcation stenosis co-existing with ipsilateral middle cerebral artery stenosis.