急性大血管闭塞性轻型卒中血管内治疗的疗效及安全性观察

doi:10.3969/j.issn.1673-5765.2020.10.011

摘要/Abstract

摘要：

目的观察急性大血管闭塞性轻型卒中患者血管内治疗的疗效及安全性。方法回顾性分析2018年1月-2019年5月行血管内治疗的急性大血管闭塞性轻型卒中（NIHSS评分 ≤5分）患者的临床资料。观察术后血管成功再通率（mTICI≥2b级）、围手术期并发症、90 d良好预后率（mRS评分≤2分）等。结果共纳入13例患者，平均年龄58.7±14.5岁，男性11例（84.6%）。术后血管成功再通率100%；围手术期并发症2例，假性动脉瘤1例、无症状性颅内出血1例；90 d良好预后率100%。结论急性大血管闭塞性轻型卒中行血管内治疗可能是安全、有效的。

文章导读： 本研究回顾性急性大血管闭塞性轻型卒中患者，早期进行血管影像评估，根据病因选择合适的个体化血管开通策略，血管内治疗可能是安全、有效的。

关键词: 大血管闭塞; 轻型卒中; 血管内治疗; 疗效

Abstract:

Objective To investigate the efficacy and safety of endovascular therapy for minor stroke due to acute large vessel occlusion. Methods The clinical data of patients with acute minor stroke (NIHSS ≤5) due to large vessel occlusion from January 2018 to May 2019 was retrospectively analyzed. The recanalization (mTICI ≥2b), perioperative complications and 90-day prognosis were observed, and good prognosis was defined as a mRS score of 0-2. Results A total of 13 patients were included, with an average age of 58.7±14.5 years and 11 (84.6%) males. The recanalization rate was 100%; perioperative complications occurred in two cases, including one case of pseudoaneurysm and one case of asymptomatic cerebral hemorrhage; the 90-day good prognosis rate was 100%. Conclusions Endovascular therapy for minor stroke due to acute large vessel occlusion may be safe and effective.

Key words: Large vessel occlusion; Minor stroke; Endovascular therapy; Efficacy

刘涛，兰春伟，袁昆雄，王清勇，黎凯峰，贺雄军，刘亚杰，张亮. 急性大血管闭塞性轻型卒中血管内治疗的疗效及安全性观察[J]. 中国卒中杂志, 2020, 15(10): 1088-1093.

LIU Tao,LAN Chun-Wei, YUAN Kun-Xiong, WANG Qing-Yong, LI Kai-Feng, HE Xiong-Jun, LIU Ya-Jie, ZHANG Liang. Efficacy and Safety of Endovascular Therapy for Minor Stroke due to Acute Large Vessel Occlusion[J]. Chinese Journal of Stroke, 2020, 15(10): 1088-1093.

参考文献

[1] JOHNSTON S C，EASTON J D，FARRANT M，et

al. Clopidogrel and aspirin in acute ischemic stroke

and high-risk TIA[J]. N Engl J Med，2018，379（3）：

215-225.

[2] HELDNER M R，JUNG S，ZUBLER C，et al.

Outcome of patients with occlusions of the internal carotid artery or the main stem of the middle cerebral

artery with NIHSS score of less than 5：comparison

between thrombolysed and non-thrombolysed

patients [J]. J Neurol Neurosurg Psychiatry，2015，86

（7）：755-760.

[3] MANNO C，DISANTO G，BIANCO G，et al.

Outcome of endovascular therapy in stroke with

large vessel occlusion and mild symptoms[J/OL].

Neurology，2019，93（17）：e1618-e1626[2020-06-10].

https：//doi.org/10.1212/WNL.0000000000008362.

[4] GOYAL M，MENON B K，VAN ZWAM W H，et

al. Endovascular thrombectomy after large-vessel

ischaemic stroke：a meta-analysis of individual

patient data from five randomised trials[J]. Lancet，

2016，387（10029）：1723-1731.

[5] FISCHER U，BAUMGARTNER A，ARNOLD M，

et al. What is a minor stroke[J]. Stroke，2010，41（4）：

661-666.

[6] 中华医学会神经病学分会，中华医学会神经病学分

会脑血管病学组. 中国急性缺血性脑卒中诊治指南

2018[J]. 中华神经科杂志，2018，51（9）：666-682.

[7] BlUHMKI E，CHAMORRO A，DáVALOS A，et

al. Stroke treatment with alteplase given 3.0-4.5 h

after onset of acute ischaemic stroke（ECASS Ⅲ）：

additional outcomes and subgroup analysis of a

randomised controlled trial[J]. Lancet Neurol，2009，

8（12）：1095-1102.

[8] EGGERS C C J，BOCKSRUCKER C，SEYFANG L，

et al. The efficacy of thrombolysis in lacunar strokeevidence

from the austrian stroke unit registry[J].

Eur J Neurol，2017，24（6）：780-787.

[9] TORRES-MOZQEEDA F，HE J，YEH I B，et al. An

acute stroke classification instrument that includes

CT or MR angiography：the Boston Acute Stroke

Imaging Scale（BASIS）[J]. AJNR Am J Neuroradiol，

2008，29（6）：1111-1117.

[10] POEWES W J，RABINSTEIN A A，ACKERSON

T，et al. 2018 guidelines for the early management of

patients with acute ischemic stroke：a guideline for

healthcare professionals from the American Heart

Association/American Stroke Association[J/OL].

Stroke，2018，49（3）：e46-e110[2020-06-10].

https：//doi.org/10.1161/STR.0000000000000158.

[11] HAUSSEN D C，LIMA F O，BOUSLAMA M，et al.

Thrombectomy versus medical management for large

vessel occlusion strokes with minimal symptoms：an

analysis from STOPStroke and GESTOR cohorts[J].

J Neurointerv Surg，2018，10（4）：325-329.

[12] GRIESSENAUER C J，MEDIN C，MAIGARD

J，et al. Endovascular mechanical thrombectomy in

large-vessel occlusion ischemic stroke presenting

with low National Institutes of Health Stroke Scale：

systematic review and meta-analysis[J]. World

Neurosurg，2018，110（2）：263-269.

[13] TURC G，BHOGAL P，FISCHER U，et al. European

Stroke Organisation（ESO）- European Society for

Minimally Invasive Neurological Therapy（ESMINT）

guidelines on mechanical thrombectomy in acute

ischemic stroke[J]. J Neurointerv Surg，2019，11（6）：

535-538.

[14] SARRAJ A，HASSAN A，SAVITAZ S I，et al.

Endovascular thrombectomy for mild strokes：how

low should we go?[J]. Stroke，2018，49（10）：2398-

2405.

[15] SENERS P，PERRIN C，LAPERGUE B，et al.

Bridging therapy or IV thrombolysis in minor stroke

with large vessel occlusion[J]. Ann Neurol，2020，88

（1）：160-169.

[16] YOON W，KIM S K，PARK M S，et al. Endovascular

treatment and the outcomes of atherosclerotic

intracranial stenosis in patients with hyperacute

stroke[J]. Neurosurgery，2015，76（6）：680-686.

[17] JIA B X，FENG L，LIEBESKIND D S，et al.

Mechanical thrombectomy and rescue therapy for

intracranial large artery occlusion with underlying

atherosclerosis[J]. J Neurointerv Surg，2018，10（8）：

746-750.

[18] 中国卒中学会，中国卒中学会神经介入分会，中华预

防医学会，等. 替罗非班在动脉粥样硬化性脑血管疾

病中的临床应用专家共识[J]. 中国卒中杂志，2019，

14（10）：1034-1044.

[19] KIM Y W，HONG J M，PARK D G，et al. Effect of

intracranial atherosclerotic disease on endovascular

treatment for patients with acute vertebrobasilar

occlusion[J]. AJNR Am J Neuroradiol，2016，37

（11）：2072-2078.