急性缺血性脑卒中急诊介入开通治疗的临床观察

目的探讨急诊行介入开通术治疗急性缺血性脑卒中（AIS）的有效性、安全性及个体化治疗方案。 方法收集31例经DSA提示为脑动脉主干血管闭塞、行急诊介入开通术的AIS患者的临床资料并进行回顾分析，评估该手术方式的技术成功率、疗效及风险。 结果31例患者中获得血管再通的24例，技术成功率达77.42%（24/31），其中19例达到术后即刻血管完全再通（TICI 3级），5例部分再通（TICI 2级）。获得血管再通的24例中，8例采用接触溶栓法，16例采用机械开通如球囊扩张、自膨式支架置入或Solitaire取栓中的一种或几种获得。术后死亡7例（7/31，22.58%），其中因颅内出血死亡2例（2/31，6.45%），1例溶栓后，1例机械取栓后，出血均发生在术后12 h内；因大面积梗死致亡5例（5/31，16.13%），2例因血管部分开通后再次急性血栓形成，3例因血管未开通而闭塞症状逐渐加重死亡。90天随访中达到预后良好（MRS≤2分）的患者占51.61%（16/31），其中血管获得完全再通的患者预后良好率达78.95%（15/19），术前DSA证实有侧支代偿的患者预后良好率达57.89%（11/19）。 结论急诊行介入开通术治疗AIS是可行、有效、较安全的，并有可能成为急性脑动脉主干血管闭塞患者的首选治疗方式。

Clinical observation of emergency endovascular recanalization therapies for acute ischemic stroke

ObjectiveTo explore the efficacy, safety and individuation of emergency endovascular recanalization in treatment of acute ischemic stroke (AIS). MethodsThe clinical d ata of 31 patients with AIS and DSA showed main trunk occlusion, who underwent emergency intervention operation were retrospectively analyzed, to evaluate the technical success rate, efficacy and the risk. ResultsAmong 31 patients, 24 cases were recanalized successfully, technical success rate was 77.42% (24/31), including 19 cases achieved immediate postoperative blood vessel recanalization (TICI grade 3), 5 cases partial recanalization (TICI grade 2). In the 24 recanalized patients, 8 cases underwent superselective intra-arterial contact thrombolysis, 16 cases underwent mechanical endovascular recanalization therapies including balloon mechanical expanding, self-expanding type stent implantation or solitaire stent clot-retrieval. Among 31 patients, 7 cases (7/31, 22.58%) died and 2 of them were died of intracranial hemorrhage (2/31, 6.45%), each occurred within 12 h after thrombolysis and thrombectomy, 5 cases died of large infarction (5/31, 16.13%), including 2 cases of acute thrombus recurrent and 3 cases failed to recanalize and infarction symptoms aggravated. In the 90 days’ follow-up, the discharge patients who had good prognosis (MRS≤2) accounted for 51.61% (16/31), for these patients, complete recanalizationrate was 78.95% (15/19), with lateral branch compensatory verified by preoperative DSA was 57.89% (11/19). ConclusionsEmergency endovascular recanalization for AIS is feasible, effective and safer. It has the potential to be the first choice for cases with main trunk occlusion.