经颅多普勒超声脑缺血溶栓分级与阿替普酶静脉溶栓治疗急性前循环不同大动脉闭塞性脑梗死预后相关性研究

目的探讨分析经颅多普勒超声脑缺血溶栓分级与静脉溶栓治疗急性前循环不同大动脉闭塞性脑梗死患者血管再通评价与预后的相关性研究。方法选择急性前循环大动脉闭塞性脑梗死患者,对符合静脉溶栓者给予阿替普酶静脉溶栓治疗,分别于溶栓前及溶栓后24 h行床旁经颅多普勒超声(transcranial Doppler,TCD)检查并记录脑缺血溶栓分级(thrombolysis in brain ischemia,TIBI)。采用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分记录患者临床神经功能缺损,3个月随访时采用改良Rankin量表(modified Rankin Scale,m RS)评分评估患者预后,分析前循环不同大血管闭塞性脑梗死患者静脉溶栓前后血管再通情况及患者3个月预后。结果共入选46例患者,其中颈内动脉(internal carotid artery,ICA)闭塞患者19例,大脑中动脉(middle cerebral artery,MCA)闭塞患者27例。溶栓前与溶栓后24 h TCD监测TIBI分级提示血管再通者,ICA闭塞组5.26%,MCA闭塞组55.56%。ICA闭塞组与MCA闭塞组比较,MCA闭塞组90 d随访生活自理及良好预后的比例均高于ICA闭塞组,死亡率低于ICA闭塞组,而两组间溶栓后的症状性颅内出血发生率差异无显著性。结论急性前循环大动脉闭塞性脑梗死经静脉溶栓治疗后可获得血管再通,尤其是MCA闭塞患者;溶栓前后TIBI血流分级变化可反映大动脉血管再通情况,且有助于判断患者临床预后。     

颈内动脉和大脑中动脉狭窄与闭塞患者的64排螺旋CT脑容积灌注成像

目的探讨64排螺旋CT脑容积灌注成像（CT perfusion imaging,CTP）与头颈CT血管成像（CT angiography,CTA）联合应用在颈内动脉（internal carotid artery,ICA）或大脑中动脉（middlecerebral artery,MCA）狭窄与闭塞患者中的应用价值.方法对5名健康人及17例患者（ICA狭窄11例、MCA狭窄6例）行CT平扫、CTP和CTA检查,分析灌注延迟表现与病变动脉及其狭窄程度的关系.结果17例患者8例CT平扫未见异常,9例有腔隙性脑梗死和（或）陈旧脑梗死.平均通过时间（mean transit time,MTT）和达峰时间（time to peak,TTP）图灌注延迟表现分为3型：Ⅰ型病变仅累及MCA区,Ⅱ型病变仅累及分水岭区,Ⅲ型病变累及MCA和分水岭区.ICA重度狭窄或闭塞患者Ⅲ型7例,MCA重度狭窄或闭塞患者Ⅰ型4例.64排CT可同时获得容积CTP和颅底动脉环动态CTA,其动态CTA图像质量与常规CTA近似.结论MTT、TTP能够敏感显示灌注损伤,对ICA或MCA重度狭窄或闭塞诊断、治疗及脑梗死发病机制研究有重要价值.64排CT可得到包括基底节在内的上下8个层面的图像,可以更多地显示16层以下螺旋CT显示不到的病变,如脑干、小脑的梗死等.CTP联合CTA能够早期诊断脑梗死,并同时从功能和形态学上综合分析脑缺血的程度和原因,获得更详细的信息,为临床医师尽早进行合理治疗提供客观的影像学依据.     

动脉粥样硬化性急性颅内前循环大血管闭塞的血管内再通治疗研究

目的探讨对颅内动脉粥样硬化性急性前循环大血管闭塞患者行血管内再通治疗的疗效。方法回顾性纳入河南省人民医院神经介入科2014年6月至2016年6月收治的49例颅内动脉粥样硬化性前循环大血管闭塞患者,所有患者均行血管内再通治疗。术中采用脑梗死溶栓（TICI）分级进行血管再通评价;术后24 h行头颅CT检查,判断有无颅内出血;术后1周对患者行美国国立卫生研究院卒中量表（NIHSS）评估神经功能改善情况。出院后对所有患者行门诊或电话随访根据改良Rankin量表评分（mRS）判断患者预后,对置入支架患者行数字减影血管造影（DSA）检查,观察颅内支架有无再狭窄。结果49例患者血管再通时间平均为（78.4±29.0）min。87.8%（43/49）的患者术中实现成功再通（TICI 2b、3级）。术中发生栓塞5例,其中1例患者经支架远端取栓治疗再通,3例患者使用动脉内盐酸替罗非班注射治疗（2例成功再通）。术后24 h 7例患者出现颅内出血,其中3例为症状性出血。术后1周NIHSS评分平均为（8.8±4.1）分,较术前显著降低[（15.6±3.9）分,P〈0.001]。49例患者出院后3个月均获得随访,6例死亡,mRS评分平均为（2.9±1.7）分,预后良好率为57.1%（28/49）。出院后6个月15例支架置入患者中,2例（13.3%）患者出现支架内再狭窄。结论动脉粥样硬化性颅内急性大血管闭塞患者行血管内再通治疗可以实现较高的再通率及良好预后。     

伴颅内外动脉狭窄或闭塞的分水岭脑梗死类型分析

目的探讨由颈内动脉(ICA)或大脑中动脉(MCA)狭窄或闭塞引起的分水岭脑梗死(WSI)的梗死类型及发病机制。方法 81例急性WSI患者根据责任血管分为ICA组(53例)及MCA组(28例)。根据MRI检查结果对两组梗死类型进行分析比较。结果 ICA组皮质前型及皮质前型+内WSI+皮质后型的比率显著高于MCA组(均P<0.05)。结论合并颅内外血管狭窄或闭塞WSI类型以内WSI及皮质后型梗死最常见。ICA病变患者WSI皮质前型常见,其发病机制可能为血流动力学障碍;MCA病变患者WSI皮质上型及合并融合性病灶多见,其机制可能为微栓子对远端血管的微栓塞。     

症状性颅内动脉闭塞患者脑灌注缺损与侧支循环的相关性研究

目的 研究症状性颅内动脉闭塞患者脑灌注缺损与侧支循环的关系。 方法 回顾性纳入2017年1月-2018年10月于解放军总医院第一医学中心连续收治的症状性单侧颈 内动脉（internal carotid artery,ICA）颅内段或大脑中动脉（middle cerebral artery,MCA）M1/M2段闭塞 患者,根据闭塞部位分为ICA闭塞组和MCA闭塞组。收集患者临床资料并记录影像学特征,采用定量 分析软件获取患侧脑血流残余功能达峰时间（time to maximum of the residual function,Tmax）>4 s和 Tmax>6 s的低灌注区容积,并采用多时相CTA 6级评分法对侧支循环进行评分。比较两组患者低灌注 区容积与侧支循环的差异,并分析低灌注区容积与侧支循环评分的相关性。 结果 最终纳入42例患者,平均年龄54.9±13.9岁,男性29例（69.0%）,其中I CA闭塞组19例,MCA 闭塞组23例。ICA闭塞组Tmax>4 s容积（163.1±98.6 mL vs 64.6±54.2 mL,P <0.001）、Tmax>6 s容积 （92.4±87.1 mL vs 13.0±27.6 mL,P <0.001）均大于MCA闭塞组;ICA闭塞组侧支循环评分低于MCA闭 塞组[3（2～4）分 vs 4（3～4）分,P =0.021]。ICA闭塞组Tmax>4 s 、Tmax>6 s容积与侧支循环评分呈负相关 （r =-0.667,P =0.002;r =-0.717,P <0.001）;MCA闭塞组Tmax>4 s 、Tmax>6 s容积与侧支循环评分呈负 相关（r =-0.498,P =0.016;r =-0.494,P =0.017）。 结论 症状性颅内动脉闭塞患者低灌注区容积与闭塞部位及侧支循环相关,ICA闭塞患者较MCA闭 塞患者有更大的低灌注缺损和更差的侧支循环。     

尿激酶静脉溶栓联合Solitaire AB支架取栓在前循环大动脉急性闭塞性脑梗死治疗中的应用研究

目的探讨尿激酶静脉溶栓联合Solitaire AB支架取栓治疗急性前循环大血管闭塞性脑梗死的临床疗效。方法选取鄂尔多斯市中心医院神经内科2015年10月至2016年4月急性脑梗死(ACI)患者8例,进行尿激酶静脉溶栓后采用Solitaire AB取栓装置进行支架取栓术,其中大脑中动脉闭塞4例,颈内动脉和大脑中动脉串联病变2例,颈内动脉末端T型病变2例,分析8例患者的临床特征、影像学资料、治疗及术后3月临床随访结果。以支架取栓后再通率、治疗前后美国国立卫生研究院卒中量表(NIHSS)评分及术后3个月随访时改良Rankin量表(mRs)评分评估治疗的有效性;以及手术相关并发症、病死率评估治疗的安全性。结果 8例患者在尿激酶静脉溶栓后行Solitaire AB支架取栓均成功实现血管再通,改良脑梗死溶栓试验(m TICI)分级2b或3级。出院时NIHSS评分中位数6(0,12)分,较术前16.5(12,24)分明显下降(P<0.05),未发生操作相关永久性并发症。6例预后良好(mRS评分为0~2分),1例因梗死后出血残疾(mRS评分为3~4分);1例患者因大面积脑梗死而死亡。结论尿激酶静脉溶栓联合Solitaire AB型支架取栓术治疗急性大脑中动脉和颈内动脉起始段与大脑中动脉串联闭塞(Tandem ICA/MCA,TIM)患者能获得较高的血管再通率,临床预后较好,但对颈内动脉末端闭塞患者效果不理想,死亡率高。     

颈内和大脑中动脉狭窄与闭塞的梗死类型及卒中机制的研究

目的 研究单侧动脉粥样硬化性MCA/ICA狭窄与闭塞的急性缺血性脑卒中患者在DWI上的梗死类型及发病机制.方法 起病48h内DWI诊断的急性脑梗死伴有动脉粥样硬化性MCA/ICA狭窄与闭塞的131例患者,有潜在心源性栓子患者除外.急性期DWI上梗死病灶分为：（1）单发病灶（小的穿动脉梗死灶;大的穿动脉梗死灶,皮层支梗死,大面积梗死,分水岭梗死）;（2）多发梗死病灶.结果 131例患者,ICA51例,MCA80例.ICA出现最多的梗死类型：穿支动脉伴分水岭梗死,但与MCA比较,皮层支伴分水岭梗死具有统计学意义（8/51,P=0.001）.MCA以穿支动脉伴皮层支梗死最多,且与ICA比较,具有统计学意义（12/80,P=0.003）.MCA中任何皮层支梗死与狭窄程度无关,ICA中任何分水岭梗死与狭窄程度相关.结论 颈内和大脑中动脉狭窄与闭塞在DWI上的梗死类型有明显的不同,提示有着不同的卒中发病机制.     

腔隙性脑梗死102例患者的脑血流动力学分析

目的 依据神经影像学资料分析腔隙性脑梗死患者脑和血管病变及其发病机制。方法 对102例腔隙性脑梗死患者进行头颅MRI、CT血管造影（CTA）、CT灌注成像（CTP）检查。结果 单发腔隙性脑梗死3例，多发腔隙性脑梗死99例。CTA显示颈内动脉（ICA）重度狭窄或闭塞32例，轻-中度狭窄19例。中动脉（MCA）重度狭窄或闭塞11例，轻-中度狭窄5例。ICA或MCA粥样硬化23例，正常血管12例。CTP显示ICA-MCA供血区内血流灌注异常56例。结论 腔隙性脑梗死可能由大动脉狭窄或闭塞所造成的远端小动脉血流灌注减低和微栓子所致。     

串联病变是急性基底动脉闭塞血管内治疗预后不良的危险因素:单中心队列研究

目的探讨串联病变对急性基底动脉闭塞患者血管内治疗预后的预测价值。方法纳入2012年1月至2018年7月共187例急性基底动脉闭塞患者(包括串联病变25例、非串联病变162例),均行血管内治疗,术前采用后循环Alberta脑卒中计划早期CT评分(pc-ASPECTS)和脑桥-中脑指数(PMI)评价脑梗死范围,后交通评分和美国介入和治疗性神经放射学学会/美国介入放射学学会(ASITN/SIR)分级评价基底动脉闭塞后后循环侧支代偿。主要预后指标为术后即刻血管再通率以及治疗后90 d功能独立性和预后,主要安全终点为术后7 d内颅内出血和症状性颅内出血发生率以及治疗后90 d病死率。结果串联病变组患者病变主要位于基底动脉起始部(包括椎动脉颅内段)和远端(P=0.000)、合并颅内动脉狭窄比例较低(P=0.000)。25例串联病变患者中21例采取Dirty-road路径、4例采取Clean-road路径,支架取栓(P=0.030)和术中静脉注射替罗非班(P=0.028)比例更低,支架植入比例更高(P=0.005),术后即刻血管再通率更低(P=0.001),治疗后90 d病死率更高(P=0.002)。单因素和多因素Logistic回归分析显示,串联病变是急性基底动脉闭塞术后即刻血管再通率较低(OR=0.050,95%CI:0.010～0.530;P=0.012)和治疗后90 d病死率较高(OR=17.320,95%CI:2.700～111.040;P=0.003)的危险因素。结论串联病变是急性基底动脉闭塞患者血管内治疗后预后不良的危险因素。     

急性脑梗死动脉内药物溶栓和机械支架再通比较

目的观察急性脑梗死患者脑血管特点,比较动脉内尿激酶溶栓、机械再通和支架成形的安全及有效性。方法对发病1．5—8h的11例急性腩梗死患者,行全脑血管数字减影（DSA）造影,给予动脉内治疗;进行血管再通评价,美国国立卫生院神经功能缺损评分（National Institutes of Health Stroke Scale,NIHSS）和1个月改良Rankin量表评分。结果术前NIHSS为6～21。责任血管闭塞6例（54．5％）;重度狭窄3例（27．3％）;未见异常2例（18．2％）。2例闭塞粗管行闭塞局部尿激酶溶栓,未再通,术后1例出血死亡,1例大面积脑梗死,改良Rankin量表评分为5;3例血管闭塞行机械再通后支架成形;1例同侧责任血管闭塞伴对侧颈内动脉重度狭窄和3例同侧责任血管重度狭窄行狭窄处支架成形,术后血管均再通,无出血;2例DSA检查未见异常病例仅药物治疗。后3组1个月改良Rankin量表评分为0～1。结论急性脑梗死时对于闭塞施管机械再通较尿激酶溶栓血管再通可靠,对于重度狭窄血管可行支架治疗。     

Local intra-arterial fibrinolysis in acute hemispheric stroke: effect of occlusion type and fibrinolytic agent on recanalization success and neurological outcome

BACKGROUND: To evaluate the effect of occlusion type and fibrinolytic agent on recanalization success and clinical outcome in patients undergoing local intra-arterial fibrinolysis (LIF) in acute hemispheric stroke. METHODS: LIF was performed in 137 patients with angiographically established occlusion in the carotid circulation within 6 h of stroke onset. Retrospective analysis included recanalization success, recanalization time, type of occlusion and fibrinolytic treatment mode. Five types of occlusion were categorized: intracranial bifurcation (carotid 'T') of the internal carotid artery (ICA; n = 35); proximal segment of the middle cerebral artery (MCA; n = 66); distal segment of the MCA (n = 20); extracranial ICA with MCA embolism (n = 8); multiple peripheral branches of the anterior cerebral artery and the MCA (n = 8). Neurologic outcome was evaluated after 3 months by Barthel Index (BI) as good (BI >90), moderate (BI 50-90), poor (BI <50) or death. RESULTS: Recanalization was achieved in 74 patients (54%). Mean recanalization time in recanalized patients was 91 min. Neurologic outcome was good in 48 patients (35%), moderate in 34 (25%), poor in 30 (22%) and 25 died (18%). Outcome was significantly better in recanalized than in nonrecanalized patients (p < 0.001). Treatment results were significantly better in proximal and distal MCA occlusion than in carotid 'T' occlusions (p < 0.001). Recanalization success hardly differed between urokinase and rt-PA. Combined treatment with rt-PA and lys-plasminogen tended toward a faster recanalization. Parenchymal hemorrhage occurred in 13 patients (9%). CONCLUSION: The type of occlusion is of high prognostic value for successful fibrinolysis in the anterior circulation. However, recanalization is a time-consuming process even with an intra-arterial approach. Recanalization did not differ between type or dosage of plasminogen activators. Further innovative attempts are warranted towards hastening recanalization time in endovascular acute stroke treatment.     

Color-coded Ultrasound Diagnosis of Vascular Occlusion in Acute Ischemic Stroke

A combination of extracranial and transcranial color-coded sonography was used to identify the patterns of vascular occlusion in 47 patients with acute ischemic stroke. Total anterior circulation infarction (n = 20) was associated with internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion (n = 8 and 9, respectively), or with significant reduction in ipsilateral MCA velocities (n = 5) Patients with partial anterior circulation (n = 22) infarction had patency of the ipsilateral ICA and MCA. In this group, significant reduction of ipsilateral MCA velocities (n = 7) was associated with more extensive infarcts on conventional neuroimaging (n = 6), suggesting multiple MCA branch occlusions. Ultrasound imagmg was unable to identify underlying vascular pathology in patients with postenor circulation infarction or with lacunar infarction (n = 5). An ultrasound-based approach enables noninvasive identification of major vascular pathology of the anterior cerebral circulation in patients with acute cerebral infarction. It may be useful for the rapid identification of patients most and those least likely to benefit from acute intervention, and for monitoring their response.     

急性脑梗死散在和单一弥散加权成像病损与其供血动脉狭窄的关系

目的 探讨急性脑梗死弥散加权磁共振成像(DWI)上大脑中动脉(MCA)供血区散在性或单一性缺血性病损与其脑供血动脉狭窄或闭塞的关系.方法 回顾性分析73例连续积累的DWI显示一侧MCA供血区脑梗死的病例,入组病例均排除心源性栓塞性脑梗死,所有患者均在发病24 h内进行MRI和MRA等检查,7例患者并进行DSA.采用DWI急性缺血性病损分类方法 分为散在病损组和单一病损组,比较两组的病灶同侧MCA、颈内动脉(ICA)颅内段和颅外段狭窄或闭塞的发生率.结果 散在病损组42例,单一病损组31例.在病损同侧ICA颅外段和MCA闭塞或重度狭窄方面两组差异有统计学意义(28.6%与0,x2=10.6,P=0.001).在病损同侧ICA颅内段并MCA轻中度狭窄方面,两组间差异具有统计学意义(31.0%与9.7%,x2=4.717,P=0.03).散在病损与MCA和(或)ICA严重或多发狭窄呈正相关(OR值为13.7,95%CI:3.6～52.5).在MRA或DSA未发现颅内外大血管狭窄方面,两组间差异具有统计学意义(11.9%与32.3%,x2=4.526,P=0.033).散在病损组与无明显血管狭窄呈负相关(OR值为0.284,95%CI:0.09～0.94).结论 (1)脑梗死急性期DWI显示的MCA区散在性病损患者,MCA和ICA狭窄、甚至闭塞的可能性较大,以ICA颅外段闭塞较为常见;(2)DWI显示单一病损时提示脑供血动脉狭窄程度较轻,范围较局限,小血管病变的可能性相对较高,很少为严重的ICA颅外段狭窄或闭塞.

Abstract：

Objective To investigate the relationship between scattered or single lesion of acute cerebral infarction in middle cerebral artery territory on diffusion-weighted imaging (DWI) and stenosis of middle cerebral artery (MCA) or internal carotid artery (ICA). Methods With exclusion of cardioembolism, 73 consecutive patients with acute cerebral infarction of the unilateral MCA territory on DWI were analyzed. All patients got magnetic resonance imaging (MRI) and angiography (MRA) within 24 hours after onset, and 7 patients also had digital subtraction angiography (DSA). The patients were classified into single lesion group or scattered lesions group according to the DWI findings. The incidence of stenosis or occlusion of ipsolateral MCA, intracranial and extracranial ICA were compared between the two groups. Results 42 patients had scattered lesions and 31 patients had single lesion. The scattered-lesions group had a high incidence of ipsilateral extracranial ICA or MCA occlusion or severe stenosis ( 25.6%versus 0, x2 = 10.6, P = 0.001 ) and a high incidence of ipsilateral intracranial ICA or MCA moderate or mild stenosis (31.0% versus 9.7% ,x2 =4.717, P =0.03 ). A positive correlation was found between the scattered lesions and severe or multifocal stenosis of ipsilateral ICA and MCA ( OR: 13.7, 95% CI: 3.6 to 52.5). There was a low incidence of absence of extra- and intracranial stenosis on MRA or DSA in the scattered-lesions group ( 11.9% versus 32.3%, x2= 4.526, P = 0.033 ). A negative correlation was found between the scattered lesions and absence of large-artery stenosis ( OR: 0.284, 95% CI: 0.09 to 0.94).Conclusions ( 1 ) Patients with acute cerebral infarction and scattered lesions on DWI were more likely to suffer from stenosis or occlusion of ICA or MCA, especially over the extracranial ICA. (2) Patients with single lesion were less likely to have severe or multiple stenosis of MCA and ICA, indicating the relevance of small-vessel pathogenesis.     

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。     

Factors affecting the angiographic recanalization and early clinical improvement in middle cerebral artery territory infarction after thrombolysis

BACKGROUND: Factors affecting the angiographic recanalization (AR) and clinical improvement (CI) still remain unclear in patients receiving thrombolytic therapy. OBJECTIVES: To elucidate factors related to AR and early CI in patients with middle cerebral artery (MCA) or internal carotid artery (ICA) occlusion. DESIGNS: Retrospective study. SETTING: Department of Neurology, Asan Medical Center, Seoul, South Korea. PATIENTS: We studied 42 patients who (1) underwent diffusion-weighted magnetic resonance (MR) imaging and MR angiography within 6 hours after onset, (2) had MCA territory infarction, (3) had nonvisualization of the MCA or the ICA on initial MR angiography, (4) were treated with thrombolytics, and (5) underwent follow-up MR imaging and MR angiography at day 2 or 3. RESULTS: Successful AR and CI were achieved in 31 and 16 patients, respectively. Angiographic recanalization was related to CI (P<.01), lower follow-up National Institutes of Health Stroke Scale scores (P<.05), the absence of a dominant ipsilateral posterior cerebral artery (P<.01) on initial MR angiography, and the sparing of the internal capsule on both initial (P<.05) and follow-up (P<.01) MR imaging. Clinical improvement was associated with the absence of ICA (vs MCA) flow signals (P<.05), the sparing of the internal capsule (P<.01), and marginally, with the infarct volume change (P = .06). CONCLUSIONS: In patients with MCA or ICA occlusion, CI after thrombolysis is related to the AR and the sparing of the critical motor pathway. The presence of a dominant ipsilateral posterior cerebral artery may predict poor AR after thrombolysis.     

Stent for temporary endovascular bypass and thrombectomy in major ischemic stroke

Endovascular techniques for acute stroke have evolved from a pharmacological to a mechanical approach. We report illustrative cases of successful anterior circulation recanalization in patients with large arterial occlusions, using a stent-based technique to perform arterial recanalization and thrombectomy, without permanent stent implantation. Four patients (mean age 59 years), presented with National Institutes of Health Stroke Scale (NIHSS) scores of 18 to 24, from 2 hours to 6 hours after stroke onset, with middle cerebral artery (MCA), MCA branch, internal carotid artery (ICA) terminus, or tandem ICA-MCA occlusions. A closed-cell stent was temporarily inserted to achieve temporary endovascular bypass, and then used as a thrombectomy device during withdrawal. Rapid and complete recanalization with successful thrombectomy was achieved in all patients within 28 minutes to 52 minutes. One week after treatment patients achieved NIHSS scores of 2 to 5, with no hemorrhagic complications. This approach allowed rapid endovascular revascularization and thrombectomy, without permanent stent implant. Stent-based thrombectomy devices may become a valuable tool in the management of acute ischemic stroke.     

动脉夹层所致急性前循环大血管闭塞性卒中血管内治疗疗效分析

目的 探讨颈动脉夹层引起的急性前循环大血管闭塞性缺血性卒中血管内治疗的安全性和有效性。 方法 回顾性纳入2019年1-12月在南方医科大学深圳医院连续行急诊血管内治疗的前循环大血管 闭塞患者,根据血管闭塞病因分为动脉夹层组和非动脉夹层组。血管再通效率指标为穿刺-血管再通 时间和影像学上血管成功再通（mTICI≥2b级）,主要的疗效评价指标为90 d良好预后（mRS评分≤2 分）,主要安全评价指标为术后24 h内症状性颅内出血。 结果 共纳入56例,平均年龄58.5±9.7岁,男性42例（75.0%）,12例为动脉夹层引起的血管闭塞, 44例为非动脉夹层引起的血管闭塞。两组患者90 d良好预后率（83.3% vs 61.4%,P =0.189）、24 h症 状性颅内出血率（25.0% vs 31.8%,P =0.738）、血管成功再通率（91.7% vs 93.2%,P＞0.99）均无统计 学差异,动脉夹层组穿刺-血管再通时间长于非动脉夹层组（124.5 min vs 83 mi n,P =0.008）。 结论 颈动脉夹层引起的急性前循环大血管闭塞性卒中,行血管内治疗安全有效。     

急性缺血性脑卒中血管内治疗21例临床分析

目的探讨急性缺血性脑卒中血管内治疗的方法、疗效和安全性。方法回顾性分析血管内治疗的大血管闭塞的急性缺血性脑卒中患者21例。10例为阿替普酶静脉溶栓后桥接血管内治疗,11例直接行血管内治疗。其中机械取栓12例,机械取栓+支架植入3例,单纯颈动脉支架植入3例,机械取栓+动脉溶栓1例,机械取栓+动脉溶栓+支架植入1例,单纯动脉溶栓1例。评估术中mTICI再通等级、并发症及术后随访第90天m RS评分,分析疗效与安全性。结果21例患者前循环卒中18例,后循环卒中3例。NIHSS评分平均15. 81±6. 44分。20例患者术后血管再通达mTICI 2 b-3级。术中并发出血1例,术后大量颅内出血1例,无症状少量颅内出血4例。术后高灌注综合征8例,其中4例行去骨瓣减压术,最终死亡5例(23. 81%)。术后随访第90天mRS评分0～2分8例。结论经充分评估并及时采取适宜的单一或多种血管内治疗方法对于大血管闭塞导致的急性缺血性脑卒中患者安全有效。