症状性颈动脉漂浮血栓的血管内治疗探索

doi:10.3969/j.issn.1673-5765.2023.10.006

摘要/Abstract

摘要： 目的探索症状性颈动脉漂浮血栓（carotid free-floating thrombus，CFFT）血管内治疗的临床疗效与安全性。
方法回顾性纳入2008年8月—2022年11月在西安交通大学第二附属医院神经内科住院诊断为症状性CFFT，并行颈动脉支架置入术的患者，分析CFFT患者临床表现、危险因素、病变部位、颈动脉支架器材、手术方式及临床效果。
结果共纳入6例CFFT导致急性脑梗死的患者，其中女性4例（66.7%），发病年龄中位数63.5（48.0～68.7）岁。术前NIHSS评分中位数3.0（0～3.5）分，mRS评分中位数2.0（1.0～3.0）分。6例患者中，血栓位于右侧颈总动脉中远段1例，左侧颈内动脉C1段1例，右侧颈内动脉C1段4例，2例患者合并颈动脉原位重度狭窄。患者均接受了远端保护装置下的支架置入术，2例合并原位狭窄者支架置入前进行了球囊预扩张。5例患者置入了Wallstent闭环支架，1例患者置入了Precise开环支架。所有患者术中均未发生血栓脱落、远端大血管闭塞事件。1例（16.7%）患者术后12 h因支架内血栓发生脑水肿及病情加重。所有患者术后7 d NIHSS评分中位数减至1.0（0～3.0）分，术后90 d mRS评分中位数为1.0（0～2.0）分。
结论颈动脉支架置入术可能是治疗症状性CFFT的一种可行的安全有效的方法。

文章导读： 症状性颈动脉漂浮血栓的最佳治疗方法尚不明确，对抗栓药物治疗效果不佳的CFFT患者，颈动脉支架置入术可能是一种安全、有效的方法。

关键词: 漂浮血栓; 缺血性卒中; 血管内治疗; 颈动脉支架置入术; 颈动脉

Abstract: Objective This study aimed to explore safety and efficiency of endovascular therapy for symptomatic carotid free-floating thrombus (CFFT).
Methods Patients admitted to the Department of Neurology, the Second Affiliated Hospital of Xi´an Jiaotong University from August 2008 to November 2022 and diagnosed with symptomatic CFFT and treated with carotid artery stenting were retrospectively enrolled. For each patient clinical presentation, risk factors, location of the thrombus, type of carotid stent and adjunctive devices, surgical approach, clinical efficacy were recorded and analyzed.
Results A total of 6 patients with acute cerebral infarction caused by CFFT were included, with 4 females (66.7%) , the median age at onset was 63.5 (48.0-68.7) years. The median NIHSS was 3.0 (0-3.5) and mRS was 2.0 (1.0-3.0) at pre-operation. The CFFT was located in the distal segment of right common carotid artery in 1 case, the C1 segment of left internal carotid artery in 1 case and right internal carotid artery in 4 cases. 2 cases with CFFT had severe carotid stenosis. All patients were treated with carotid stenting under protection of distal filter device. Balloon predilation was used in 2 cases with severe carotid stenosis before carotid stenting. The Wallstent closed-cell stent was used in 5 patients with the Precise open-cell stent being used in 1 patient. None of the patients had clot migration or distal intracranial large vessel occlusion. In one case (16.7%) in-stent thrombosis occurred and this induced brain edema and symptom aggravation. The median NIHSS was 1.0 (0-3.0) at 7 days after operation, and mRS was 1.0 (0-2.0) at 90 days follow-up.
Conclusions Carotid artery stenting may be a feasible approach for symptomatic CFFT with good safety and efficiency profile.

Key words: Free-floating thrombus; Ischemic stroke; Endovascular therapy; Carotid stenting; Carotid

张磊, 王小雅, 坚雅婷, 高震, 樊洪, 范松华, 王虎清, 孙宏, 张茹, 展淑琴, 张桂莲. 症状性颈动脉漂浮血栓的血管内治疗探索[J]. 中国卒中杂志, 2023, 18(10): 1136-1142.

ZHANG Lei, WANG Xiaoya, JIAN Yating, GAO Zhen, FAN Hong, FAN Songhua, WANG Huqing, SUN Hong, ZHANG Ru, ZHAN Shuqin, ZHANG Guilian. Exploration into Endovascular Therapy of Symptomatic Carotid Free-floating Thrombus[J]. Chinese Journal of Stroke, 2023, 18(10): 1136-1142.

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