Clinical analysis of 16 cases of remedial stent placement after mechanical thrombectomy for acute cerebral infarction

中国综合临床 Pub Date : 2020-03-01 DOI:10.3760/CMA.J.ISSN.1008-6315.2020.02.008

Q. Zhu, Qi Sun

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Abstract

Objective To explore the efficacy and safety of the remedial stent implantation after mechanical thrombectomy for acute cerebral infarction. Methods From October 2014 to December 2018, the clinical data of 16 patients with acute cerebral infarction who could not maintain forward blood flow after mechanical thrombectomy in 985 Hospital of joint service support force of PLA were analyzed retrospectively.To analyze the score of National Institutes of Health Stroke Scale (NIHSS), degree of vascular recanalization after operation thrombolysis incerebral infarction(TICI) classificatio, mechanical thrombolytic number, postoperative vascular reocclusion rate, incidence of intracranial hemorrhage, NIHSS score 1 week later, good clinical result after 90 days(improved Rankin scale, mRs= 0-2) and other indicators. Results After mechanical embolectomy, 16 stents were implanted (15 of them were Solitaire stents, 1 of them was Apollo stents), 12 patients with TICI=3, and 4 patients with TICI=2b.The average number of times of mechanical thrombectomy was(3.25±1.09). Balloon expansion was performed before stent placement in 7 patients with limited stenosis.The time from the onset to the reperfusion was(10.96 ± 3.24) hours. Computed tomography angiography(CTA) was reexamined 24 hours after operation, showing vascular of 3 cases were reocclusion and 3 cases occured intracranial hemorrhage(all less than 10 ml). In 2 cases of decompressive osteotomy, NIHSS score was improved from preoperative (24.25±4.58) points to postoperative (7.44±5.09) points.After 90 days, 10 patients had a good prognosis (mRs ≤ 2) and 1 patient died (pulmonary infection). Conclusion After mechanical thrombectomy of acute cerebral infarction, if there is severe stenosis or forward blood flow can not be maintained, use the Solitaire stent or other stent to remedy the placement, with fewer complications and better clinical effect. Key words: Acute ischemic stroke; Stent implantation; Remedial treatment; Mechanical thrombectomy

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急性脑梗死机械取栓后行支架置入术16例临床分析

目的探讨急性脑梗死机械取栓后支架置入术的疗效和安全性。方法回顾性分析2014年10月至2018年12月解放军联勤保障部队985医院机械取栓后不能维持前方血流的16例急性脑梗死患者的临床资料。分析美国国立卫生研究院卒中量表(NIHSS)评分、术后血管再通程度、脑梗死溶栓(TICI)分类、机械溶栓次数、术后血管再闭塞率、颅内出血发生率、1周后NIHSS评分、90天后临床效果良好(改进型Rankin量表，mRs= 0-2)等指标。结果机械栓塞切除术后植入支架16例(其中Solitaire支架15例，Apollo支架1例)，TICI=3的患者12例，TICI=2b的患者4例。机械取栓次数平均为(3.25±1.09)次。7例局限性狭窄患者在置入术前行球囊扩张术。从发病到再灌注时间为(10.96±3.24)小时。术后24小时复查ct血管造影(CTA)， 3例血管再闭塞，3例颅内出血，均小于10 ml。2例行减压截骨术，NIHSS评分由术前(24.25±4.58)分提高至术后(7.44±5.09)分。90 d后，10例预后良好(mRs≤2)，1例死亡(肺部感染)。结论急性脑梗死机械取栓后，若存在严重狭窄或不能维持前向血流，可采用接龙支架或其他支架补置，并发症少，临床效果好。关键词:急性缺血性脑卒中;支架植入术;补救治疗;机械血栓切除术

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来源期刊

中国综合临床

CiteScore

0.10

自引率

0.00%

发文量

16855

期刊介绍： Clinical Medicine of China is an academic journal organized by the Chinese Medical Association (CMA), which mainly publishes original research papers, reviews and commentaries in the field. Clinical Medicine of China is a source journal of Peking University (2000 and 2004 editions), a core journal of Chinese science and technology, an academic journal of RCCSE China Core (Extended Edition), and has been published in Chemical Abstracts of the United States (CA), Abstracts Journal of Russia (AJ), Chinese Core Journals (Selection) Database, Chinese Science and Technology Materials Directory, Wanfang Database, China Academic Journal Database, JST Japan Science and Technology Agency Database (Japanese) (2018) and other databases.