Effect of interventional therapy in the treatment of acute occlusion caused by middle cerebral artery stenosis
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摘要: 目的 探讨大脑中动脉狭窄并发急性闭塞的介入治疗手术策略及术后管理措施。 方法 回顾性分析32例大脑中动脉狭窄导致急性闭塞患者的临床资料, 分析患者的影像学资料、术中治疗策略、术后管理措施及术后3个月的临床随访结果。以术后血管再通率［采用改良脑梗死溶栓(mTICI)分级评估］、治疗前后美国国立卫生研究院卒中量表(NIHSS)评分以及术后3个月改良Rankin量表(mRS)评分评估疗效,以术后1周手术并发症发生率评估治疗安全性。 结果 32例患者取栓后均发现大脑中动脉狭窄,分别予单纯抗血小板治疗、抗血小板治疗基础上单纯支架植入、球囊扩张以及球扩支架植入治疗, mTICI分级为Ⅱa 3例、Ⅱb 5例、Ⅲ级24例; 本组患者术后1周NIHSS评分中位数为5.6分,较术前12.6分显著下降(P<0.05), 均未出现手术并发症; 3个月后随访, 29例患者预后良好(mRS评分0~2分), 3例残疾(mRS评分3~4分)。 结论 大脑中动脉狭窄并发急性闭塞的介入治疗要根据患者具体情况采取相应治疗策略,术中及术后的抗血小板及降脂治疗、血压管理至关重要。Abstract: Objective To evaluate operation strategy of interventional therapy in the treatment of acute occlusion caused by middle cerebral artery stenosis and its postoperative management. Methods The clinical data of 32 patients with acute occlusion caused by middle cerebral artery stenosis were retrospectively reviewed. The imaging findings, intraoperation treatment strategy, postoperative management measures and the clinical follow-up results at 3 months after treatment were analyzed. The vascular recanalization rate after operation ［evaluated by modified thrombolysis in cerebral infarction(mTICI)grading］, National Institutes of Health Stroke Scale(NIHSS)scores before and after treatment, and the modified Rankin Scale(mRS)at 3 months after treatment were used to evaluate the efficacy. The safety of treatment was evaluated by incidence of surgery-related complication at 1 week after operation. Results It was found that 32 patients had middle cerebral artery stenosis after thrombectomy, and were respectively treated by antiplatelet alone, stent implantation alone based on antiplatelet therapy, and ballon dilatation and ballon-expandable stent implantation. The results of mTICI grading showed that there were 3 cases with Ⅱa grading, 5 cases with Ⅱb grading, and 24 cases with Ⅲ grading. The postoperative NIHSS score(with median score of 5.6)of theses patients at 1 week after treatment was decreased significantly compared with 12.6 before treatment(P<0.05), and no postoperative complications were found in these patients. The 3-month follow-up results showed that 29 patients had favorable prognosis(mRS score of 0 to 2)and 3 had disability(mRS score of 3 to 4). Conclusion The corresponding treatment strategy should be taken in interventional treatment for stenosis caused by acute middle cerebral artery occlusion, and intraoperative and postoperative antiplatelet treatment, lipid-lowering therapy and blood pressure management are of great importance.
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