急性缺血性脑卒中患者早期血管内管理的最新指南及其实施的实践方面

А.М. Netliukh, V. Shevaga, A. Payenok, В.M. Salo, О.Ya. Kobyletskyi
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引用次数: 0

摘要

目的:评价多档案医院介入放射科动脉内治疗急性缺血性脑卒中的安全性和有效性。材料和方法。2015-2017年间,15名颈动脉循环急性缺血性卒中患者接受了紧急血管内治疗。在最近的6例和2例病例中(2017年)使用了支架取出器血栓切除和血栓抽吸的机械动脉内治疗;7例采用动脉内溶栓治疗(2015-2016)。后果本文简要回顾了有关急性缺血性脑卒中治疗的文献,并对选定患者的治疗结果进行了讨论。机械血栓切除术或血栓抽吸术在75.0%的病例中有效,再通率良好,而在7例接受动脉内或rt-PA桥接溶栓治疗的患者中有效率为42.9%。以下以2例临床病例为例,讨论了机械血栓切除术在近期缺血性卒中治疗临床指南方面的意外技术失败。结论。缺血性脑卒中的血管内治疗具有很高的安全性和众所周知的疗效。在我们的患者中,很明显,在大多数病例中,遵循目前的支架取出器血栓切除术或颅内动脉颅外和近端血栓闭塞后血栓抽吸的管理指南,可以在2017年达到再灌注率2b/3改良脑缺血治疗量表。在42.9%的病例中,动脉内溶栓使脑缺血改良治疗量表中的再灌注率为2b/3,这表明其有效性较低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Recent guidelined for the early endovascular management of patients with acute ischemic stroke and practical aspects of their implementation
Objective — to estimate safety and effectiveness of intra-arterial treatment for acute ischemic stroke in the interventional radiology department of multiprofile hospital. Materials and methods. Urgent endovascular treatment was applied at 15 patients with acute ischemic stroke in carotid circulation during 2015–2017. Mechanical intra-arterial therapy with thrombectomy by stent-retrievers and thromboaspiration was used at accordingly six and two recent cases (during 2017); in 7 cases intra-arterial thrombolysis was the treatment option (2015–2016). Results. The article consist brief review of literature about acute ischemic stroke treatment and discussion concerning results of treatment of selected patients. Mechanical thrombectomy or thromboaspiration were effective in 75.0 % of cases with good recanalization rate opposite to 42.9 % at 7 patients treated by either intra-arterial or bridging thrombolysis with rt-PA. Unexpected technical failures of mechanical thrombectomy regarding recent clinical guidelines for ischemic stroke management following are discussed on example of 2 clinical cases. Conclusions. Endovascular treatment of ischemic stroke has a high safety and well-known efficacy. It became evident at our patients that following current management guidelines for thrombectomy with stent-retrievers or thromboaspiration after thrombotic occlusions of extracranial and proximal segments of intracranial arteries allowed attaining in 2017 reperfusion rate 2b/3 Modified Treatment in Cerebral Ischaemia Scale in majority of cases. Intra-arterial thrombolysis contributed to the reperfusion rate 2b/3 on the Modified Treatment in Cerebral Ischaemia scale just in 42.9 % of cases, which indicates its lower effectiveness.
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