急性缺血性卒中取栓失败后的大脑中动脉支架治疗
Title：Middle cerebral artery stenting for acute ischemic stroke after unsuccessfulMerci retrieval.
Author： Sauvageau E, Samuelson RM, Levy EI, Jeziorski AM, Mehta RA, Hopkins LN.
Resource: Neurosurgery. 2007 Apr;60(4):701-6; discussion 706.
标题：急性缺血性卒中取栓失败后的大脑中动脉支架治疗
来源：神经病学，2007年四月第60卷第四期，701-706页，讨论在706页。
Abstract：OBJECTIVE: Intracranial stenting has been used in the treatment of ischemic stroke caused by acute intracranial vessel occlusion after unsuccessful recanalization with the Merci retriever. We describe our early experience with this technique.
摘要：
目的：对急性颅内血管栓塞采用Merci取栓器治疗，但未能实现血管再通。颅内支架植入术已被用于上述原因引起的缺血性卒中。我们阐述了使用该项技术的初步经验。
METHODS: Patients who had intra-arterial therapy for acute ischemic stroke with concomitant use of the retriever between February 1, 2005 and May 2, 2006 were identified from our endovascular database. Cases in which recanalization was not achieved with the retriever and in which stenting was attempted as a secondary means of mechanical recanalization were retrospectively reviewed.
方法：从我们的血管内数据库中选取曾接受介入治疗急性缺血性卒中的患者，同时他们还曾在2005年2月1日到2006年5月2日期间接受过取栓治疗。患者接受取栓治疗失败没能成功实现血管再通，继而对其尝试采用了机械再通的第二种方式——支架植入术。本文对这些病例进行了回顾性分析。
RESULTS: Ten patients with unsuccessful Merci retrieval underwent intracranial stenting. The average admission National Institutes of Health Stroke Scale score was 16.4. Occlusions were located in the middle cerebral artery (six extended into M2 branches). Four patients received intra-arterial reteplase (two prestent, one preretriever and poststent, and one poststent). Eptifibatide was administered immediately before stenting in every patient. Successful recanalization (thrombolysis in myocardial infarction 2 or 3) was achieved in nine out of 10 patients. Complications included an extradural perforation with arteriovenous fistula. Six patients had intracranial hematoma and/or subarachnoid hemorrhage; there were four deaths. The six surviving patients experienced at least a 6-point National Institutes of Health Stroke Scale improvement at discharge, although only one had a modified Rankin Scale score of 2 or less.
结果：取栓失败的10名患者接受了颅内支架植入术。患者入院时，美国国立卫生研究院卒中量表平均为16.4分。栓塞位于大脑中动脉（6个延伸入M2分支中）。四名患者经动脉给予瑞替普酶（两名于支架植入前，一名于取栓前和支架植入后，一名于支架植入后）。每名患者即将行支架植入术前给予埃替非巴肽。10名患者当中9人成功实现血管再通（心肌梗死溶栓）。并发症包括硬膜外穿孔伴动静脉瘘。6名患者发生颅内血肿和/或蛛网膜下腔出血；四名患者死亡。6名存活患者出院时国立卫生研究院卒中量表至少改善6分，但只有一名患者其改良Rankin量表小于等于2分。
CONCLUSION: Angiographic recanalization has been associated with improvement in clinical outcome after acute cerebral ischemia. Recanalization is not always achieved using the Merci retriever. We found that stenting after unsuccessful Merci retrieval resulted in a high rate of
angiographic success. Further research into refining indications and optimizing outcome is warranted.
结论：血管造影再通与急性脑缺血临床预后的改善密切相关。使用Merci取栓器有时并不能成功实现血管再通。我们发现Merci取栓失败后行支架植入术可实现更高的血管造影成功率。尚需开展进一步研究以改进指证和优化预后。
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