Effect of interventional therapy in the treatment of acute occlusion caused by middle cerebral artery stenosis

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.