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目的:评价紧急支架植入术治疗急性缺血性卒中(acute ischemic stroke,AIS)的有效性和安全性。方法:对动脉溶栓术后再通血管残余狭窄≥70%患者8例进一步行支架植入术。以90天时改良mRS(modified Rankin Scale,mRS,)评分评价预后,分为生活自理(mRS≤2分)、依赖((mRS3～5分)和死亡(mRS6分)。结果:8例患者平均年龄65±15岁,范围35～72岁,美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)基线评分18±8.6分,范围12～30分。闭塞位置包括:颈内动脉(internal carotid artery,ICA)终末段1例,C1段2例,M1段1例,椎基底动脉4例。支架在所有病例均被成功放置,8例患者有7例血管再通成功(Thrombolysis in Myocardial Ischemia,TIMI,2/3);术后支架内急性血栓形成1例,没有症状性出血。90天时患者生活独立5例,依赖1例,死亡2例(均为卒中进展家属放弃治疗)。结论:紧急支架植入术提高了血管再通率,安全性可接受。支架置入可能防止狭窄动脉发生再闭塞。
Objective: To evaluate the effectiveness and safety of emergency stent implantation in the treatment of acute ischemic stroke (AIS). Methods: Eight patients with residual stenosis ≥70% after arterial thrombolysis were further treated with stent implantation. The mRS score was used to evaluate the prognosis at 90 days.Results: The average age of 8 patients (mRS≤2), dependent (mRS 3 ~ 5) and death (mRS6) 65 ± 15 years, ranged from 35 to 72 years, and the National Institutes of Health Stroke Scale (NIHSS) baseline score was 18 ± 8.6 points in the range of 12 to 30. The occlusion sites included: the internal carotid artery 1 case of internal carotid artery (ICA), 2 cases of C1, 1 case of M1 and 4 cases of vertebrobasilar artery. The stent was successfully placed in all cases and 7 of 8 patients had successful recanalization (Thrombolysis in Myocardial Ischemia, TIMI, 2/3). There was 1 case of acute thrombosis in the scaffold without symptomatic hemorrhage.On 90 days, there were 5 patients living independently, 1 patient died and 2 died. Conclusion: Emergency stenting improves the recanalization rate and is safe, and stenting may prevent occlusion of the stenotic artery.