中国卒中杂志 ›› 2020, Vol. 15 ›› Issue (02): 135-140.DOI: 10.3969/j.issn.1673-5765.2020.02.005
王亚军,范铁平,李迪
收稿日期:
2019-07-13
出版日期:
2020-02-20
发布日期:
2020-02-20
通讯作者:
李迪 jzlidi@126.com
Received:
2019-07-13
Online:
2020-02-20
Published:
2020-02-20
摘要:
目的 观察SWIM技术治疗后循环大血管闭塞所致急性缺血性卒中的有效性及安全性。 方法 回顾性分析2017年2月-2018年11月于大连市中心医院采用SWIM技术治疗的后循环大血管闭 塞所致急性缺血性卒中患者的临床资料,评价该技术的疗效和安全性,并分析影响患者预后的因素。 观察指标为术后即刻成功再通(mTICI≥2b)、90 d良好预后(mRS评分≤2分),以及术后24 h任何颅内 出血、90 d全因死亡。 结果 共纳入35例患者,平均年龄66.1±12.1岁,男性26例(74.3%),基线NIHSS评分22(15~34)分。 术后即刻成功再通率为94.3%(33/35),90 d良好预后率为45.7%(16/35),24 h颅内出血率为17.1% (6/35),90 d全因死亡率为37.1%(13/35)。单因素分析显示,基线NIHSS评分较低(P =0.001)、基 线后循环ASPECTS评分较高(P =0.016)、发病至到院时间较短(P =0.039)、发病至再通时间较短 (P =0.047)、血管成功再通率较高(P =0.036)以及饮酒比例较低(P =0.042)与良好预后相关。 结论 使用SWIM技术治疗后循环急性缺血性卒中相对安全、有效。
王亚军,范铁平,李迪. SWIM技术治疗后循环大血管闭塞所致急性缺血性卒中的有效性和安全性观察[J]. 中国卒中杂志, 2020, 15(02): 135-140.
WANG Ya-Jun, FAN Tie-Ping, LI Di. Efficacy and Safety of SWIM Technique for Acute Ischemic Stroke Due to Large Vessel Occlusion in Posterior Circulation[J]. Chinese Journal of Stroke, 2020, 15(02): 135-140.
[1] 中国卒中学会,中国卒中学会神经介入分会,中华预防医学会卒中预防与控制专业委员会介入学组. 急性缺血性卒中血管内治疗中国指南2018[J]. 中国卒中杂志,2018,13(7):706-729.[2] MATTLE H P,ARNOLD M,LINDSBERG P J,etal. Basilar artery occlusion[J]. Lancet Neurol,2011,10(11):1002-1014.[3] LINDSBERG P J,MATTLE P. Therapy of basilarartery occlusion:a systematic analysis comparingintra-arterial and intravenous thrombolysis[J]. Stroke,2006,37(3):922-928.[4] SCHONEWILLE W J,WIJMAN C A,MICHELP,et al. Treatment and outcomes of acute basilarartery occlusion in the Basilar Artery InternationalCooperation Study(BASICS):a prospectiveregistry study[J]. Lancet Neurol,2009,8(8):724-730.[5] JANG-HYUN B,MOON K B,HOE H J,et al.Number of stent retriever passes associated withfutile recanalization in acute stroke[J]. Stroke,2018,49(9):2088-2095.[6] VERGOUWEN M D,ALGRA A,PFEFFERKORNT,et al. Time is brain(stem)in basilar arteryocclusion[J]. Stroke,2012,43(11):3003-3006.[7] NAGEL S,KELLERT L,MÖHLENBRUCHM,et al. Improved clinical outcome after acutebasilar artery occlusion since the introduction ofendovascular thrombectomy devices[J]. CerebrovascDis,2013,36(5-6):394-400.[8] MÖHLENBRUCH M,STAMPFL S,BEHRENS L,et al. Mechanical thrombectomy with stent retrieversin acute basilar artery occlusion[J]. AJNR Am JNeuroradiol,2014,35(5):959-964.[9] HUO X,GAO F,SUN X,et al. Endovascularmechanical thrombectomy with the Solitaire devicefor the treatment of acute basilar artery occlusion[J].World Neurosurg,2016,89:301-308.[10] BAEK J M,YOON W,KIM S K,et al. Acutebasilar artery occlusion:outcome of mechanicalthrombectomy with Solitaire stent within 8 hours ofstroke onset[J]. AJNR Am J Neuroradiol,2014,35(5):989-993.[11] BROUSSALIS E,HITZL W,MCCOY M,etal. Comparison of endovascular treatment versusconservative medical treatment in patients withacute basilar artery occlusion[J]. Vasc EndovascularSurg,2013,47(6):429-437.[12] MOURAND I,MACHI P,NOGUÉ E,et al.Diffusion-weighted imaging score of the brainstem:a predictor of outcome in acute basilar arteryocclusion treated with the Solitaire FR device[J].AJNR Am J Neuroradiol,2014,35(6):1117-1123.[13] MOURAND I,MACHI,P,MILHAUD,D,et al.Mechanical thrombectomy with the Solitaire devicein acute basilar artery occlusion[J]. J NeurointervSurg,2014,6(3):200-204.[14] UNO J,KAMEDA K,OTSUJI R,et al. Mechanicalthrombectomy for acute basilar artery occlusion inearly therapeutic time window[J]. CerebrovascularDiseases,2017,44(3-4):217-224.[15] KHATRI P,ABRUZZO T,YEATTS S D,et al.Good clinical outcome after ischemic stroke withsuccessful revascularization is time-dependent[J].Neurology,2009,73(13):1066-1072.[16] KIM Y W,HONG J M,PARK D G,et al. Effect ofintracranial atherosclerotic disease on endovasculartreatment for patients with acute vertebrobasilarocclusion[J]. AJNR Am J Neuroradiol,2016,37(11):2072-2078.[17] GILBERTI N,GAMBA M,PREMI E,et al.Endovascular mechanical thrombectomy in basilarartery occlusion:variables affecting recanalizationand outcome[J]. J Neurol,2016,263(4):707-713.[18] GIORGIANNI A,BIRASCHI F,PIANO M,etal. Endovascular treatment of acute basilar arteryocclusion:Registro Endovascolare LombardoOcclusione Basilar Artery(RELOBA)study groupexperience[J]. J Stroke Cerebrovasc Dis,2018,27(9):2367-2374.[19] LUO G,MO D,TONG X,et al. Factors Associatedwith 90-day outcomes of patients with acuteposterior circulation stroke treated by mechanicalthrombectomy[J/OL]. World Neurosurg,2018,109:e318-e328[2019-07-13]. https://doi.org/10.1016/[1] 中国卒中学会,中国卒中学会神经介入分会,中华预防医学会卒中预防与控制专业委员会介入学组. 急性缺血性卒中血管内治疗中国指南2018[J]. 中国卒中杂志,2018,13(7):706-729.[2] MATTLE H P,ARNOLD M,LINDSBERG P J,etal. Basilar artery occlusion[J]. Lancet Neurol,2011,10(11):1002-1014.[3] LINDSBERG P J,MATTLE P. Therapy of basilarartery occlusion:a systematic analysis comparingintra-arterial and intravenous thrombolysis[J]. Stroke,2006,37(3):922-928.[4] SCHONEWILLE W J,WIJMAN C A,MICHELP,et al. Treatment and outcomes of acute basilarartery occlusion in the Basilar Artery InternationalCooperation Study(BASICS):a prospectiveregistry study[J]. Lancet Neurol,2009,8(8):724-730.[5] JANG-HYUN B,MOON K B,HOE H J,et al.Number of stent retriever passes associated withfutile recanalization in acute stroke[J]. Stroke,2018,49(9):2088-2095.[6] VERGOUWEN M D,ALGRA A,PFEFFERKORNT,et al. Time is brain(stem)in basilar arteryocclusion[J]. Stroke,2012,43(11):3003-3006.[7] NAGEL S,KELLERT L,MÖHLENBRUCHM,et al. Improved clinical outcome after acutebasilar artery occlusion since the introduction ofendovascular thrombectomy devices[J]. CerebrovascDis,2013,36(5-6):394-400.[8] MÖHLENBRUCH M,STAMPFL S,BEHRENS L,et al. Mechanical thrombectomy with stent retrieversin acute basilar artery occlusion[J]. AJNR Am JNeuroradiol,2014,35(5):959-964.[9] HUO X,GAO F,SUN X,et al. Endovascularmechanical thrombectomy with the Solitaire devicefor the treatment of acute basilar artery occlusion[J].World Neurosurg,2016,89:301-308.[10] BAEK J M,YOON W,KIM S K,et al. Acutebasilar artery occlusion:outcome of mechanicalthrombectomy with Solitaire stent within 8 hours ofstroke onset[J]. AJNR Am J Neuroradiol,2014,35(5):989-993.[11] BROUSSALIS E,HITZL W,MCCOY M,etal. Comparison of endovascular treatment versusconservative medical treatment in patients withacute basilar artery occlusion[J]. Vasc EndovascularSurg,2013,47(6):429-437.[12] MOURAND I,MACHI P,NOGUÉ E,et al.Diffusion-weighted imaging score of the brainstem:a predictor of outcome in acute basilar arteryocclusion treated with the Solitaire FR device[J].AJNR Am J Neuroradiol,2014,35(6):1117-1123.[13] MOURAND I,MACHI,P,MILHAUD,D,et al.Mechanical thrombectomy with the Solitaire devicein acute basilar artery occlusion[J]. J NeurointervSurg,2014,6(3):200-204.[14] UNO J,KAMEDA K,OTSUJI R,et al. Mechanicalthrombectomy for acute basilar artery occlusion inearly therapeutic time window[J]. CerebrovascularDiseases,2017,44(3-4):217-224.[15] KHATRI P,ABRUZZO T,YEATTS S D,et al.Good clinical outcome after ischemic stroke withsuccessful revascularization is time-dependent[J].Neurology,2009,73(13):1066-1072.[16] KIM Y W,HONG J M,PARK D G,et al. Effect ofintracranial atherosclerotic disease on endovasculartreatment for patients with acute vertebrobasilarocclusion[J]. AJNR Am J Neuroradiol,2016,37(11):2072-2078.[17] GILBERTI N,GAMBA M,PREMI E,et al.Endovascular mechanical thrombectomy in basilarartery occlusion:variables affecting recanalizationand outcome[J]. J Neurol,2016,263(4):707-713.[18] GIORGIANNI A,BIRASCHI F,PIANO M,etal. Endovascular treatment of acute basilar arteryocclusion:Registro Endovascolare LombardoOcclusione Basilar Artery(RELOBA)study groupexperience[J]. J Stroke Cerebrovasc Dis,2018,27(9):2367-2374.[19] LUO G,MO D,TONG X,et al. Factors Associatedwith 90-day outcomes of patients with acuteposterior circulation stroke treated by mechanicalthrombectomy[J/OL]. World Neurosurg,2018,109:e318-e328[2019-07-13]. https://doi.org/10.1016/[1] 中国卒中学会,中国卒中学会神经介入分会,中华预防医学会卒中预防与控制专业委员会介入学组. 急性缺血性卒中血管内治疗中国指南2018[J]. 中国卒中杂志,2018,13(7):706-729.[2] MATTLE H P,ARNOLD M,LINDSBERG P J,etal. Basilar artery occlusion[J]. Lancet Neurol,2011,10(11):1002-1014.[3] LINDSBERG P J,MATTLE P. Therapy of basilarartery occlusion:a systematic analysis comparingintra-arterial and intravenous thrombolysis[J]. Stroke,2006,37(3):922-928.[4] SCHONEWILLE W J,WIJMAN C A,MICHELP,et al. Treatment and outcomes of acute basilarartery occlusion in the Basilar Artery InternationalCooperation Study(BASICS):a prospectiveregistry study[J]. Lancet Neurol,2009,8(8):724-730.[5] JANG-HYUN B,MOON K B,HOE H J,et al.Number of stent retriever passes associated withfutile recanalization in acute stroke[J]. Stroke,2018,49(9):2088-2095.[6] VERGOUWEN M D,ALGRA A,PFEFFERKORNT,et al. Time is brain(stem)in basilar arteryocclusion[J]. Stroke,2012,43(11):3003-3006.[7] NAGEL S,KELLERT L,MÖHLENBRUCHM,et al. Improved clinical outcome after acutebasilar artery occlusion since the introduction ofendovascular thrombectomy devices[J]. CerebrovascDis,2013,36(5-6):394-400.[8] MÖHLENBRUCH M,STAMPFL S,BEHRENS L,et al. Mechanical thrombectomy with stent retrieversin acute basilar artery occlusion[J]. AJNR Am JNeuroradiol,2014,35(5):959-964.[9] HUO X,GAO F,SUN X,et al. Endovascularmechanical thrombectomy with the Solitaire devicefor the treatment of acute basilar artery occlusion[J].World Neurosurg,2016,89:301-308.[10] BAEK J M,YOON W,KIM S K,et al. Acutebasilar artery occlusion:outcome of mechanicalthrombectomy with Solitaire stent within 8 hours ofstroke onset[J]. AJNR Am J Neuroradiol,2014,35(5):989-993.[11] BROUSSALIS E,HITZL W,MCCOY M,etal. Comparison of endovascular treatment versusconservative medical treatment in patients withacute basilar artery occlusion[J]. Vasc EndovascularSurg,2013,47(6):429-437.[12] MOURAND I,MACHI P,NOGUÉ E,et al.Diffusion-weighted imaging score of the brainstem:a predictor of outcome in acute basilar arteryocclusion treated with the Solitaire FR device[J].AJNR Am J Neuroradiol,2014,35(6):1117-1123.[13] MOURAND I,MACHI,P,MILHAUD,D,et al.Mechanical thrombectomy with the Solitaire devicein acute basilar artery occlusion[J]. J NeurointervSurg,2014,6(3):200-204.[14] UNO J,KAMEDA K,OTSUJI R,et al. Mechanicalthrombectomy for acute basilar artery occlusion inearly therapeutic time window[J]. CerebrovascularDiseases,2017,44(3-4):217-224.[15] KHATRI P,ABRUZZO T,YEATTS S D,et al.Good clinical outcome after ischemic stroke withsuccessful revascularization is time-dependent[J].Neurology,2009,73(13):1066-1072.[16] KIM Y W,HONG J M,PARK D G,et al. Effect ofintracranial atherosclerotic disease on endovasculartreatment for patients with acute vertebrobasilarocclusion[J]. AJNR Am J Neuroradiol,2016,37(11):2072-2078.[17] GILBERTI N,GAMBA M,PREMI E,et al.Endovascular mechanical thrombectomy in basilarartery occlusion:variables affecting recanalizationand outcome[J]. J Neurol,2016,263(4):707-713.[18] GIORGIANNI A,BIRASCHI F,PIANO M,etal. Endovascular treatment of acute basilar arteryocclusion:Registro Endovascolare LombardoOcclusione Basilar Artery(RELOBA)study groupexperience[J]. J Stroke Cerebrovasc Dis,2018,27(9):2367-2374.[19] LUO G,MO D,TONG X,et al. Factors Associatedwith 90-day outcomes of patients with acuteposterior circulation stroke treated by mechanicalthrombectomy[J/OL]. 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Improved clinical outcome after acutebasilar artery occlusion since the introduction ofendovascular thrombectomy devices[J]. CerebrovascDis,2013,36(5-6):394-400.[8] MÖHLENBRUCH M,STAMPFL S,BEHRENS L,et al. Mechanical thrombectomy with stent retrieversin acute basilar artery occlusion[J]. AJNR Am JNeuroradiol,2014,35(5):959-964.[9] HUO X,GAO F,SUN X,et al. Endovascularmechanical thrombectomy with the Solitaire devicefor the treatment of acute basilar artery occlusion[J].World Neurosurg,2016,89:301-308.[10] BAEK J M,YOON W,KIM S K,et al. Acutebasilar artery occlusion:outcome of mechanicalthrombectomy with Solitaire stent within 8 hours ofstroke onset[J]. AJNR Am J Neuroradiol,2014,35(5):989-993.[11] BROUSSALIS E,HITZL W,MCCOY M,etal. Comparison of endovascular treatment versusconservative medical treatment in patients withacute basilar artery occlusion[J]. 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