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目的探讨在优化救治流程中,应用支架取栓的方法治疗急性脑动脉闭塞(ACAO)的效果及安全性。方法回顾2013年1月至2016年12月进入优化救治流程中应用Solitaire FR支架取栓方法治疗的36例ACAO患者,血管再通标准采用m TICI分级,临床效果及预后采用美国国立卫生研究院卒中量表(NIHSS)评分,以及90 d改良Rankin评分(mRS)评价其疗效及安全性。结果 33例患者经血管内治疗后均成功开通闭塞血管(m TICI2b-3),2例患者经治疗后血管部分再通(m TICI 2a),1例患者仅有微量血流通过闭塞段(m TICI 1)。术前及术后NIHSS评分相比,差异有统计学意义(P<0.05)。术后90 d改良Rankin评分(mRS)显示预后良好。其中0分5例,1分24例,2分4例,1例失访,2例死亡。33例患者随访期内复查无血管再闭塞,无症状性脑出血并发症。结论应用机械取栓治疗ACAO是安全、有效的,但应严格把握适应证及禁忌证。
Objective To explore the effect and safety of stent thrombectomy in the treatment of acute cerebral artery occlusion (ACAO) in the optimization of treatment procedures. Methods From January 2013 to December 2016, 36 patients with ACAO treated with Solitaire FR stent thrombectomy were enrolled in the optimized rescue procedure. The standard of recanalization was m TICI classification, and the clinical effect and prognosis were evaluated using the National Institutes of Health Stroke Scale (NIHSS) score, and improved 90-day Rankin score (mRS) evaluation of its efficacy and safety. Results Totally 33 patients were successfully treated with m TICI2b-3 after endovascular treatment, 2 of them were treated with m TICI2a, and only 1 patient had micro-blood flow through occlusion (m TICI 1). The NIHSS scores before and after surgery were significantly different (P <0.05). Postoperative 90 days improved Rankin score (mRS) showed a good prognosis. There were 0 cases in 5 cases, 1 case in 24 cases, 2 cases in 4 cases, 1 case lost to follow-up and 2 cases died. 33 patients were followed up during the review of no vascular reocclusion, asymptomatic complications of cerebral hemorrhage. Conclusion The application of mechanical thrombectomy for the treatment of ACAO is safe and effective, but should be strictly controlled indications and contraindications.