切换至 "中华医学电子期刊资源库"

中华介入放射学电子杂志 ›› 2019, Vol. 07 ›› Issue (04) : 294 -299. doi: 10.3877/cma.j.issn.2095-5782.2019.04.007

所属专题: 经典病例 文献

神经介入

Solitaire FR支架解脱前球囊扩张技术在急性大血管闭塞困难取栓中的应用一例
王子栋1, 刘晓莉2, 崔庆轲1, 张萌1, 林凯1, 郝继恒1, 刘超1, 张利勇1,()   
  1. 1. 252000 山东聊城,聊城市脑科医院血管神经外科
    2. 252000 山东聊城,聊城市脑科医院呼吸内科
  • 收稿日期:2019-09-13 出版日期:2019-11-01
  • 通信作者: 张利勇
  • 基金资助:
    国家十三五科技支撑计划项目(2015BAI12B040)

The application of balloon expansion technology before the liberation of Solitaire FR stent in difficult thrombectomy for acute vascular occlusion: A case report

Zidong Wang1, Xiaoli Liu2, Qingke Cui1   

  • Received:2019-09-13 Published:2019-11-01
引用本文:

王子栋, 刘晓莉, 崔庆轲, 张萌, 林凯, 郝继恒, 刘超, 张利勇. Solitaire FR支架解脱前球囊扩张技术在急性大血管闭塞困难取栓中的应用一例[J/OL]. 中华介入放射学电子杂志, 2019, 07(04): 294-299.

Zidong Wang, Xiaoli Liu, Qingke Cui. The application of balloon expansion technology before the liberation of Solitaire FR stent in difficult thrombectomy for acute vascular occlusion: A case report[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2019, 07(04): 294-299.

图1 颅脑CTP示左侧大脑中动脉供血区域明显低灌注,代偿较差
图2 Navien导管到位后路途显示左侧大脑中动脉闭塞
图3 第1次SolitaireFR 6-30到位并释放后血流恢复,M1段主干及分叉处支架形态局部不佳
图4 第1次支架取栓后,大脑中动脉上干分支再通,余分支主干仍未见显影
图5 第2次支架置入后,大脑中动脉各分支血流恢复
图6 第2次支架取栓后大脑中动脉各分支显影良好,M1段局部见充盈缺损
图7 第3次支架置入后,支架内球囊扩张
图8 初次球扩后,造影显示大脑中动脉M1段局部仍有充盈缺损,考虑合并原位狭窄
图9 Solitaire FR 4-15支架到位并释放,造影显示原狭窄处较前改善,但仍可见局部充盈缺损
图10 再次支架内囊球扩张
图11 再次球扩后,造影显示狭窄基本消失,各分支显影良好
图12 术后病理示血栓组织中还有动脉纤维斑块组织
图13 CTA示左侧大脑中动脉血管通畅(白色箭头所指)
[1]
Goyal M, Menon BK, van Zwam WH,et al. Endovascular thrombectomy after large-vessel ischaemic stroke:a meta-analysis of individual patient data from five randomised trials[J]. Lancet,2016,387(10029):1723-1731.
[2]
Gorelick PB, Wong KS, Bae HJ,et al. Large artery intracranial occlusive disease:a large worldwide burden but a relatively neglected frontier[J]. Stroke,2008,39(8):2396-2399.
[3]
Berkhemer OA, Fransen PS, Beumer D,et al. A randomized trial of intraarterial treatment for acute ischemic stroke[J]. N Engl J Med,2015,372(1):11-20.
[4]
Campbell BC, Mitchell PJ, Kleinig TJ,et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection[J]. Engl J Med,2015,372(11):1009-1018.
[5]
Goyal M, Demchuk AM, Menon BK,et al. Randomized assessment of rapid endovascular treatment of ischemic stroke[J]. N Engl J Med,2015,372(11):1019-1030.
[6]
Jovin TG, Chamorro A, Cobo E,et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke[J]. N Engl J Med,2015,372(24):2296-2306.
[7]
Saver JL, Goyal M, Bonafe A,et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke[J]. N Engl J Med,2015,372(24):2285-2295.
[8]
Powers WJ, Derdeyn CP, Biller J,et al. 2015 American heart association/American stroke association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment:A guideline for healthcare professionals from the American heart association/American stroke association[J]. Stroke,2015,46(10):3020-3035.
[9]
中华医学会神经病学分会.中国缺血性脑血管病血管内介入诊疗指南[J].中华神经科杂志,2015,48(4):830-837.
[10]
Kim JS, Bonovich D. Research on intracranial atherosclerosis from the East and West:why are the results different?[J]. J Stroke,2014,16(3):105-113.
[11]
Mulder MJ, van Oostenbrugge RJ, Dippel DW,et al. Letter by Mulder et al Regarding Article,"2015AHA/ASA Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment:A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association"[J]. Stroke,2015,46:e235.
[12]
中国卒中学会,中国卒中学会神经介入分会,中华预防医学会卒中预防与控制专业委员会介入学组.急性缺血性卒中血管内治疗中国指南2015[J].中国卒中杂志,2015,10(7):590-606.
[13]
Levy EI, Siddiqui AH, Crumlish A,et al. First Food and Drug Administration-approved prospective trial of primary intracranial stenting for acute stroke:SARIS(stent-assisted recanalization in acute ischemic stroke)[J]. Stroke,2009,40(11):3552-3556.
[14]
Zaidat OO, Wolfe T, Hussain SI,et al. Interventionalacute ischemic stroke therapy with intracranial self-expanding stent[J]. Stroke,2008,39:2392-2395.
[15]
Baek JH, Kim BM, Kim DJ,et al. Stenting as a rescue treatment after failure of mechanical thrombectomy for anterior circulation large artery occlusion[J]. Stroke,2016,47(9):2360-2363.
[16]
Kim SJ, Seok JM, Bang OY,et al. MR mismatch profiles in patients with intracranial atherosclerotic stroke:a comprehensive approach comparing stroke subtypes[J]. J Cereb Blood Flow Metab,2009,29(26):1138-1145.
[17]
Horie N, Tateishi Y, Morikawa M,et al. Acute stroke with major intracranial vessel occlusion:Characteristics of cardioembolism and atherosclerosis-related in situ stenosis/occlusion[J]. J Clin Neurosci,2016,32:24-29.
[18]
Kim TK, Rhim JK, Lee CJ,et al. The limitations of thrombectomy with solitaireTM AB as first-line treatment in acute ischemic stroke:A single center experience[J]. J Cerebrovasc Endovasc Neurosurg,2012,14(3):203-209.
[19]
Kang DH, Kim YW, Hwang YH,et al. Instant reocclusion following mechanical thrombectomy of in situ thromboocclusion and the role of low-dose intra-arterial tirofiban[J]. Cerebrovasc Dis,2014,37(5):350-355.
[20]
Heo JH, Lee KY, Kim SH,et al. Immediate reocclusion following a successful thrombolysis in acute stroke:a pilot study[J]. Neurology,2003,60(10):1684-1687.
[21]
Kellert L, Hametner C, Rohde S,et al. Endovascular stroke therapy:tirofiban is associated with risk of fatal intracerebral hemorrhage and poor outcome[J].Stroke,2013,44(5):1453-1455.
[1] 姚金含, 王伟娜, 张玉泉. 妊娠相关深静脉血栓形成患者的预后研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 367-373.
[2] 张立一, 徐春晓, 单玉玺. sEST联合不同扩张时间EPBD治疗胆总管结石的随机临床试验[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(03): 295-298.
[3] 孙顗淼, 张颖. 糖尿病患者急性脑梗死取栓术后发生对比剂肾病的影响因素及预测模型建立[J/OL]. 中华肾病研究电子杂志, 2024, 13(04): 188-194.
[4] 石豆豆, 王新星, 王向阳, 刘震洋, 曾淑娟, 仝海波. 急性前循环大血管闭塞机械取栓的研究进展[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(02): 112-116.
[5] 赖凌峰, 黄小飞, 丁聪, 周小兵. 血流导向装置治疗血泡样动脉瘤的临床效果分析[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(03): 166-170.
[6] 陈雪梅, 潘晓虎, 杨明刚, 刘邦勇, 曹月洲, 贾振宇, 赵林波, 刘圣. 不同基底动脉弯曲度对急性基底动脉闭塞患者取栓治疗的影响[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(02): 93-99.
[7] 何中海, 贾振宇, 刘圣. 血栓负荷评分对支架取栓治疗急性前循环大血管闭塞首过效应的预测价值[J/OL]. 中华介入放射学电子杂志, 2024, 12(04): 338-343.
[8] 范金铭, 翁子瑄, 马武钦, 周斌. 经桡动脉入路在神经介入的发展与应用[J/OL]. 中华介入放射学电子杂志, 2024, 12(03): 261-266.
[9] 孙爱成, 曹月洲, 贾振宇, 赵林波, 施海彬, 刘圣. 低灌注强度比值对老年急性前循环大血管闭塞性脑卒中患者机械取栓治疗预后的影响[J/OL]. 中华介入放射学电子杂志, 2024, 12(01): 15-21.
[10] 王增龙, 顾梅, 杭宇, 刘圣, 施海彬, 包建英. 急性大血管闭塞性脑卒中患者血管内治疗后吞咽障碍发生的危险因素分析[J/OL]. 中华介入放射学电子杂志, 2024, 12(01): 10-14.
[11] 程娅雯, 韩香凝, 朱宁, 何彩莲, 张润宁, 于嘉, 韩建峰, 刘福德. 双路途指导下血管内治疗症状性非急性颈内动脉颅内段闭塞的疗效观察[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(04): 330-337.
[12] 李芳, 戴西望, 王凯, 郭廷昊, 涂江龙. 非瓣膜性心房颤动相关性卒中的治疗研究进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(04): 393-397.
[13] 于乐林, 尚海龙, 杜红娣, 王莺, 王一超, 徐长贺, 叶娟, 赵世伟, 郑芳慧, 沈慧, 沈海林. 基于CT平扫的影像组学特征预测急性大脑中动脉闭塞机械取栓术后造影剂外渗的价值[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(03): 215-223.
[14] 陈鲲鹏, 陆军, 祁鹏, 王俊杰, 胡深, 杨希孟, 邓颖, 裴傲, 王大明. 应用脑膜中动脉栓塞术治疗慢性硬脑膜下血肿的临床观察[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(03): 236-242.
[15] 许英, 彭采凤, 曾梁楠, 李倩茜, 杨昌美. 未破裂颅内动脉瘤介入治疗患者自我管理干预方案的构建[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(02): 164-170.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?