非急性症状性颅内前循环大动脉闭塞血管内治疗的疗效观察

目的探讨非急性症状性颅内前循环大动脉闭塞性疾病血管内治疗的安全性和有效性。方法回顾性分析青岛大学附属医院2016年7月至2021年2月收治的非急性颅内前循环大动脉闭塞患者的一般资料、手术资料及随访资料,包括再通成功率、围手术期并发症发生率、影像随访资料及临床随访资料。采用脑梗死溶栓试验(TICI)分级评估是否再通成功,采用美国国立卫生研究院卒中量表(NIHSS)评分评估患者治疗前后神经功能缺损程度,采用改良Rankin量表(mRS)评估术后神经功能恢复程度。结果30例颅内前循环大动脉血管内治疗病例中有28例成功开通(技术成功率为93.3%),术前mTICI分级较术后mTICI分级差异有统计学意义(P<0.05);发生6例手术并发症(并发症发生率为20.0%),包括夹层2例、高灌注综合征1例、蛛网膜下腔出血3例。术后NIHSS评分较术前NIHSS评分差异有统计学意义(P<0.05)。18例影像随访,示3人发生责任血管再狭窄,其中1例发生责任血管供血区TIA并表现为发作性对侧肢体无力,另外2例为无症状狭窄;30例临床随访,28例开通成功病例示随访mRS评分明显优于术前,差异有统计学意义(P<0.05),2例术中并发症且未开通成功病例示临床随访mRS评分较术前无显著变化。结论对于非急性症状性颅内前循环大动脉闭塞病例,血管内治疗在高度选择的病例安全且有效。

Observation on the effect of endovascular treatment for non-acute symptomatic anterior intracranial circulatory artery occlusion

Objective To investigate the safety and effectiveness of endovascular treatment for non-acute symptomatic intracranial occlusive disease of internal carotid artery.Methods The general data,surgical data and follow-up data of the patients with non-acute intracranial occlusion of internal carotid artery admitted to the Affiliated Hospital of Qingdaso Univerity from July 2016 to February 2021 were retrospectively analyzed,including the success rate of recanalization,the incidence of perioperative complications,imaging follow-up data and clinical follow-up data.Thrombolysis test for cerebral infarction(TICI)was used to evaluate the success of recanalization,the National Institutes of Health Stroke Scale(NIHSS)score was used to evaluate the degree of neurological impairment before and after treatment,and the degree of postoperative neurological recovery was evaluated by the modified Rankin Scale(MRS).Results 28 of the 30 cases of intracranial internal carotid artery were successfully opened(technical success rate was 93.3%).The difference of mTICI grading before operation was statistically significant compared with that after operation(P<0.05).Surgical complications occurred in 6 cases(20.0%),including dissection in 2 cases,hyperperfusion syndrome in 1 case,and subarachnoid hemorrhage in 3 cases.Follow-up imaging of the 18 patients showed that 3 patients had restenosis of the offending vessels.One of them had TIA in the offending vessels and presented with paroxysmic contralateral limb weakness,and the other one had asymptomatic stenosis.In the 30 cases of clinical follow-up,there was a statistically significant difference in the MRS score between the 28 cases with successful operation and that before operation(P<0.05),and there was no significant change in the MRS score during clinical follow-up between the 2 cases with intraoperative complications and unsuccessful operation.Conclusion endovascular therapy is safe and effective in highly selected cases of non-acute symptomatic intracranial internal carotid occlusion.The long-term NIHSS score and MRS score can be used to follow up the neurological deficit and recovery,and then to evaluate the long-term efficacy of endovascular therapy.