Strategy of double stent-retriever thrombectomy for acute distal basilar artery occlusion
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摘要:目的 探讨双支架取栓技术治疗急性基底动脉远端闭塞的安全性和疗效。方法 回顾性分析2015年1月—2019年5月本院脑血管病中心采用双支架取栓术治疗的5例急性基底动脉远端闭塞患者的影像学及临床资料，包括改良脑梗死溶栓分级(mTICI)、术后24 h及7 d的中位美国国立卫生研究院卒中量表(NIHSS)评分、围术期并发症以及90 d改良Rankin量表(mRS)评分。结果 本组5例患者中, 3例患者经单支架多次取栓失败后改用双支架取栓, 2例直接使用双支架取栓。所有闭塞血管均再通成功, mTICI达到2b级至3级。术后3D-CT未发现颅内出血，术后24 h及7 d的中位NIHSS评分依次为9.8、7.4分。1例患者术后死于肺部感染。随访3个月, 3例患者90 d mRS评分≤2分, 1例90 d mRS评分>2分。结论 双支架取栓技术治疗急性基底动脉远端闭塞安全、有效，血管再通率高，可以作为常规取栓不成功的补救措施。
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关键词:
- 卒中 /
- 颅内动脉 /
- 支架 /
- 机械取栓 /
- 美国国立卫生研究院卒中量表
Abstract:Objective To explore the safety and efficacy of double stent-retriever thrombectomy in treatment of acute distal basilar artery occlusion.Methods From January 2015 to May 2019, the imaging and clinical materials of 5 patients with acute distal basilar artery occlusion treated by double stent-retriever thrombectomy in center of cerebrovascular disease were analyzed retrospectively, including modified thrombolysis in cerebral infarction (mTICI), median score of the National Institutes of Health Stroke Scale (NIHSS) at 24 h and 7 days after operation, perioperative complications and score of modified Rankin Scale (MRS) within 90 days.Results Among the 5 patients in this research, 3 patients selected double stent-retriever thrombectomy after failure of single stent thrombectomy for many times, and 2 patients directly selected double stent-retriever thrombectomy. All occluded vessels were recanalized successfully, and mTICI reached grades of 2b to 3. No intracranial hemorrhage was found by 3D-CT. The median NIHSS scores were 9.8 and 7.4 points at 24 h and 7 days after operation respectively. One patient died of pulmonary infection. Three patients were followed up for 3 months. The 90 d mRS was less than or equal to 2 points in three patients, and was more than 2 points in one patient.Conclusion Double stent-retriever thrombectomy is safe and effective in the treatment of acute distal basilar artery occlusion with a high recanalization rate, which can be used as a remedy for the failure of conventional thrombectomy. -
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表 1 5例行双支架取栓术治疗的基底动脉远端闭塞患者的临床资料
序号 性别 年龄/岁 发病时间/min 入院至股动脉穿刺时间/min NIHSS/分 术后1周NIHSS/分 穿刺至再通时间/min mTICI/级 围术期并发症 90 d mRS/分 1 女 68 430 30 26 14 40 3 无 2 2 男 82 400 35 18 3 70 2b 肺部感染 - 3 男 59 180 50 26 5 80 3 无 1 4 女 62 80 55 12 7 120 3 无 1 5 男 71 480 30 26 8 30 3 无 3 NIHSS: 美国国立卫生研究院卒中量表评分; mTICI: 改良脑梗死溶栓分级; mRS: 改良Rankin量表评分。 
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