缺血性脑卒中急性期串联闭塞患者的治疗效果

S. Konotopchyk, F.G. Rzayeva, O. Pastushyn, D. Shchehlov, M. Mamonova, O. Svyrydiuk, O. Kovalenko
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In 9 (13.9 %) cases the cause of thrombosis was spontaneous dissection of the wall of the internal carotid artery. To assess collateral blood flow, the ACG scale proposed by the American Society for Interventional and Therapeutic Radiology was used. The quality of reperfusion was assessed using the eTICI scale. Analysis of the functional results of patients after 90 days from the onset of the disease was carried out according to the modified Rankine scale (mSR).Results. According to our study, a good angiographic result (eTICI 2b-3) was achieved in 54 (83.1 %) patients. Intraoperative complications were registered in 8 (12.3 %) cases. An analysis of the dependence of the quality of reperfusion on the severity of collateral compensation of a thrombosed artery showed that in patients with developed (ACG 3-4) collaterals (35 (53.8 %)) good reperfusion was achieved in 33 (94.3 %) cases, in patients with mild (ACG 0-2) collateral compensation (30 (46.2 %)) the quality of eTICI 2b-3 reperfusion was achieved only in 21 (70.0 %) cases. It was found that out of 40 (61.5 %) patients with tandem occlusion, in whom arterial puncture was performed within 6 hours after the onset of neurological symptoms, 15 (37.5 %) had 0-2 points for mSR after 90 days. When puncturing the artery later than 6 hours (25 (38.5 %) cases), a good result after 90 days was registered only in 7 (28.0 %) patients. Analysis of the influence of collaterals on the dynamics of changes according to multislice computed tomography revealed that patients with well-defined collaterals (35 (53.8 %) cases) during the control examination had ASPECTS scores from 1 to 9 points (average ‒ 5.3 points). Patients with mild collaterals (30 (46.2 %) observations)) on the ASPECTS scale during the control examination had from 0 to 6 points (average ‒ 2.2 points). During the first day or at the time of discharge, a statistically significant decrease in neurological deficit was observed in the group with successful restoration of cerebral blood flow findings.Conclusions. Many factors influence the clinical efficacy of endovascular reperfusion techniques: hypoperfusion area and area of brain damage according to computed tomography during hospitalization, quality of endovascular reperfusion, time from the onset of the disease, collateral compensation of the thrombosed artery basin, complications during surgery. 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引用次数: 0

摘要

目的:评价血管内治疗串联闭塞性急性缺血性脑卒中的疗效和安全性。材料和方法。对237例大血管闭塞性急性缺血性脑卒中行血管内再灌注的检查和治疗结果进行分析。串联闭塞(颈内动脉-大脑中动脉)65例(27.4%)。患者年龄29 ~ 84岁(平均64.8岁)。男性居多(46例,占70.8%)。串联闭塞缺血性脑卒中患者中,29例(44.6%)诊断为动脉粥样硬化血栓性脑卒中亚型,27例(41.5%)诊断为心脏栓塞性脑卒中。9例(13.9%)血栓形成的原因是颈内动脉壁自发剥离。为了评估侧支血流量,采用美国介入与治疗放射学会提出的ACG量表。采用eTICI量表评估再灌注质量。采用改良朗肯量表(mSR)对患者发病90天后的功能结果进行分析。根据我们的研究,54例(83.1%)患者获得了良好的血管造影结果(eTICI 2b-3)。术中出现并发症8例(12.3%)。再灌注质量对血栓形成动脉侧支代偿严重程度的依赖性分析显示,在成熟(ACG 3-4)侧支患者(35例(53.8%))中,33例(94.3%)获得良好的再灌注,在轻度(ACG 0-2)侧支代偿患者(30例(46.2%))中,仅21例(70.0%)获得eTICI 2b-3再灌注质量。结果发现,在40例(61.5%)串联闭塞患者中,在出现神经症状后6小时内进行动脉穿刺,15例(37.5%)在90天后mSR为0-2分。穿刺时间超过6小时的25例(38.5%),90天后效果良好的只有7例(28.0%)。根据多层螺旋ct分析络对变化动态的影响,对照检查中络明确的患者(35例(53.8%)),其ASPECTS评分为1 ~ 9分(平均- 5.3分)。对照检查时,轻络患者(30例(46.2%))在各方面量表上得分为0 ~ 6分(平均- 2.2分)。在第一天或出院时,在成功恢复脑血流结果的组中观察到具有统计学意义的神经功能缺损的减少。影响血管内再灌注技术临床疗效的因素很多:住院期间ct显示的低灌注面积和脑损伤面积、血管内再灌注质量、发病时间、血栓形成动脉盆侧支代偿、手术并发症等。明确的络是血管内再灌注成功后积极动态的预测因子。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The results of treatment of patients with tandem occlusions in the acute period of ischemic stroke
Objective – to evaluate the efficacy and safety of endovascular treatment in patients with acute ischemic stroke due to tandem occlusions.Materials and methods. The results of the examination and treatment of 237 patients with acute ischemic stroke due to large vessel occlusion who underwent endovascular reperfusion were analyzed. Tandem occlusions (internal carotid ‒ middle cerebral artery) were diagnosed in 65 (27.4 %) cases. Patient age ranged from 29 to 84 years (mean age ‒ 64.8 years). Men predominated among the patients (46 (70.8 %)). Among patients with ischemic stroke due to tandem occlusion, 29 (44.6 %) were diagnosed with atherothrombotic stroke subtype, 27 (41.5 %) had cardioembolic. In 9 (13.9 %) cases the cause of thrombosis was spontaneous dissection of the wall of the internal carotid artery. To assess collateral blood flow, the ACG scale proposed by the American Society for Interventional and Therapeutic Radiology was used. The quality of reperfusion was assessed using the eTICI scale. Analysis of the functional results of patients after 90 days from the onset of the disease was carried out according to the modified Rankine scale (mSR).Results. According to our study, a good angiographic result (eTICI 2b-3) was achieved in 54 (83.1 %) patients. Intraoperative complications were registered in 8 (12.3 %) cases. An analysis of the dependence of the quality of reperfusion on the severity of collateral compensation of a thrombosed artery showed that in patients with developed (ACG 3-4) collaterals (35 (53.8 %)) good reperfusion was achieved in 33 (94.3 %) cases, in patients with mild (ACG 0-2) collateral compensation (30 (46.2 %)) the quality of eTICI 2b-3 reperfusion was achieved only in 21 (70.0 %) cases. It was found that out of 40 (61.5 %) patients with tandem occlusion, in whom arterial puncture was performed within 6 hours after the onset of neurological symptoms, 15 (37.5 %) had 0-2 points for mSR after 90 days. When puncturing the artery later than 6 hours (25 (38.5 %) cases), a good result after 90 days was registered only in 7 (28.0 %) patients. Analysis of the influence of collaterals on the dynamics of changes according to multislice computed tomography revealed that patients with well-defined collaterals (35 (53.8 %) cases) during the control examination had ASPECTS scores from 1 to 9 points (average ‒ 5.3 points). Patients with mild collaterals (30 (46.2 %) observations)) on the ASPECTS scale during the control examination had from 0 to 6 points (average ‒ 2.2 points). During the first day or at the time of discharge, a statistically significant decrease in neurological deficit was observed in the group with successful restoration of cerebral blood flow findings.Conclusions. Many factors influence the clinical efficacy of endovascular reperfusion techniques: hypoperfusion area and area of brain damage according to computed tomography during hospitalization, quality of endovascular reperfusion, time from the onset of the disease, collateral compensation of the thrombosed artery basin, complications during surgery. Well-defined collaterals are a predictor of positive dynamics after successful endovascular reperfusion.
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