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中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2018, Vol. 06 ›› Issue (04) : 324 -328. doi: 10.3877/cma.j.issn.2095-5782.2018.04.010

所属专题： 文献；

神经介入

介入开通治疗症状性颅内动脉慢性闭塞的临床效果
常斌鸽1(), 王晨1, 盛志国1, 周宝生1, 马景鑑1,†(), 李牧1,†()   
  1. 1. 300192　天津市第一中心医院神经外科
  • 收稿日期:2018-08-16 出版日期:2018-11-01
  • 通信作者: 常斌鸽, 马景鑑, 李牧
  • 基金资助:
    天津市卫生局科技基金重点攻关项目(14KG104)

Clinical effect of endovascular revascularization in treatment for symptomatic chronic cerebrovascular artery occlusion

Binge Chang1,†(), Chen Wang1, Zhiguo Sheng1, Baosheng Zhou1, Jingjian Ma1(), Mu Li1()   

  1. 1. Department of Neurosurgery, the First Central Hospital of Tianjin, Tianjin 300192, China
  • Received:2018-08-16 Published:2018-11-01
  • Corresponding author: Binge Chang, Jingjian Ma, Mu Li
  • About author:
    Corresponding author: Chang Binge, Email:
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引用本文：

常斌鸽, 王晨, 盛志国, 周宝生, 马景鑑, 李牧. 介入开通治疗症状性颅内动脉慢性闭塞的临床效果[J]. 中华介入放射学电子杂志, 2018, 06(04): 324-328.

Binge Chang, Chen Wang, Zhiguo Sheng, Baosheng Zhou, Jingjian Ma, Mu Li. Clinical effect of endovascular revascularization in treatment for symptomatic chronic cerebrovascular artery occlusion[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2018, 06(04): 324-328.

目的：

评价介入开通治疗症状性颅内动脉慢性闭塞的疗效和安全性。

方法：

回顾性分析2008年12月至2017年12月在我科住院的27例症状性颅内动脉慢性闭塞患者，均采用介入开通治疗，分析开通情况和手术相关并发症，于术前和术后采用血流评定（TICI）分级和改良Rankin量表（mRS）评分评价治疗效果。

结果：

27例患者中，颈内动脉床突上段闭塞6例；椎-基底动脉交界区闭塞7例；双侧椎动脉颅内段或优势侧闭塞8例；大脑中动脉水平段闭塞6例。25例颅内闭塞血管成功开通，TICI由术前0级提升为3级。治疗主要采用支架和球囊扩张。2例患者围手术期出现并发症死亡，其余23例患者，在术后24个月的随访中，20例患者预后良好（mRS评分0~1分），2例患者预后中等（mRS评分2~3分），1例患者预后较差（mRS评分4~5分），随访过程中无死亡患者。

结论：

介入治疗症状性颅内血管闭塞效果肯定，再通技术要求高，但是术后仍存在一定的并发症，仍需进一步大量临床研究证实。

关键词: 颅内动脉, 慢性闭塞, 介入治疗, 随访研究
Objective:

To evaluate the curative effect and safety of endovascular revascularization in treatment of symptomatic chronic cerebrovascular artery occlusion, and to summarize the collateral circulations for symptomatic chronic cerebrovascular artery occlusion.

Methods:

The retrospective study was conducted including 27 consecutive patients with symptomatic chronic cerebrovascular artery occlusion treated with interventional reanalization, admitted to Tianjin First Central Hospital during the period from December 2008 to December 2017. The rate of recanalization and perioperative complications were evaluated. The curative effect was evaluated using thrombolysis in cerebral infarction (TICI) score and modified Rankin Scale (mRS) before and after operation.

Results:

Of the 27 patients, 6 of the upper segment of internal carotid artery were occluded, occlusion of vertebral basilar artery junction happened in 7 cases, bilateral vertebral artery intracranial or superior side occlusion occurred in 8 cases, occlusion of the middle cerebral artery happened in 6 cases, and 25 cases of intracranial occlusive vessels were successfully opened, with TICI upgraded from grade 0 to 3. The operation modes were interventional stent and balloon angioplasty. Two patients died owing to the perioperative complication. In 2 years follow-up, 20 patients reported good outcome (mRS score: 0-1) . Two patients had moderate outcome (mRS score: 2-3) and one had poor outcome (mRS score: 4-5) . No death occurred during the follow-up period. Collateral circulations for chronic cerebrovascular artery occlusion included supraclinoid segment of the internal carotid artery (n=6) , borderline of vertebrobasilar artery (n=7) , bilateral vertebral artery intracranial segment or dominant side (n=8) and middle cerebral artery level segment (n=6) .

Conclusions:

Endovascular reanalization for symptomatic chronic cerebrovascular artery occlusion seems to demonstrate technical feasibility and safety for particular patients, however, there are still some complications after the operation. A large number of clinical data still need to be confirmed.

Key words: Intracranial artery, Chronic occlusion, Interventional therapy, Follow up study
图1 典型病例（女性，41岁）行介入治疗术前术后的血管检查结果
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