目的：探讨血管内开通治疗对前循环灌注受损的非急性大动脉闭塞患者的影像学及临床症状改善情况,多维度评价其安全性及疗效。方法：纳入湖南师范大学第一附属医院（湖南省人民医院）2020年1月—2021年2月接受血管内开通治疗的非急性大动脉闭塞合并灌注受损的患者,对术前术后多模影像学及神经内科各量表进行比较,评估治疗的安全性及有效性。结果：共13例患者接受研究,其中大脑中动脉闭塞（MCAO）6例,颈内动脉闭塞（ICAO）7例。11例患者实现血管再通,术后30天神经功能缺损情况及功能独立率、术后90天认知功能均较术前明显好转。其中,部分患者进行影像学随访可见血管再通成功患者均未出现再狭窄,且随着血流动力学逐渐恢复,CBF、MTT、TTP绝对值均趋于正常。结论：对于前循环灌注受损的非急性闭塞患者,行血管内开通治疗是可行、有效且相对安全的,可改善患者的整体预后及生活质量,其疗效及长期预后仍需更大规模的研究进一步评估。
Abstract
Objective Investigating the improvement of imaging and clinical symptoms of endovascular recanalization for large artery occlusion (LAO) with impaired anterior circulation perfusion and evaluating the safety and efficacy of endovascular opening therapy in multiple dimensions. Methods patients with non-acute LAO with impaired anterior circulation perfusion in Hunan Provincial People’s Hospital were included from January 2020 to February 2021, who were all treated with endovascular recanalization. We compared the multimode imaging and neurology scales between preoperative and postoperation to explore the safety and effectiveness of the treatment. Results A total of 13 patients were accept this study, including 6 cases with MCAO and 7 cases with ICAO.11 patients were successfully operated. Preoperative CTP showed that compared with that in the healthy side, The neurological deficits and functional independence rate at 30 days after operation、the cognitive function at 90 days after surgery were all improved significantly compare with preoperative. In addition, the radiographic follow-up some patients showed that no restenosis occurred in the patients with successful recanalization, and with the gradual recovery of hemodynamics, the absolute values of CBF, MTT and TTP tended to be normal. Conclusion Endovascular recanalization for LAO with impaired anterior circulation perfusion is feasible, relatively and relatively safe, improving patients’overall prognosis and quality of life. Further larger scale studies are needed to evaluate the efficacy and long-term outcome associated with this treatment.
关键词
前循环 /
非急性闭塞 /
介入再通 /
灌注受损
Key words
anterior circulation /
non-acute occlusion /
interventional recanalization /
hypoperfusion
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基金
湖南省教育厅科学研究项目“对于前循环灌注受损的慢性颅内动脉闭塞患者行开通治疗的价值”（19A330）
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