血管成形术治疗颅内动脉粥样硬化性狭窄相关急性大血管闭塞临床分析陈巨罗 许 静 王国防 王福星 王幼萌
阜阳市人民医院，安徽 阜阳 236000
通信作者：王幼萌
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摘要】
目的 分析颅内动脉粥样硬化性狭窄（ICAS）相关急性大血管闭塞（LVO）患者的临床特点和血管成形术治疗的效果及临床转归。
方法 回顾性分析阜阳市人民医院于 2020-01—2021-12 收治的 15 例急性颅内动脉粥样硬化性狭窄相关急性大血管闭塞（ICAS-LVO）患者的临床资料，分析患者的影像学特点、术后血流恢复、并发症及 90 d 临床转归。
结果 15 例患者中，12 例为前循环，3 例为后循环；2 例 发病机制为动脉-动脉栓塞，13 例为低灌注/栓子清除障碍、动脉-动脉栓塞；8 例临床表现为进展性卒中，且均为晚时间窗内；15 例均予以取栓后支架植入，术后予以替罗非班静脉维持 24 h。90 d 随访显示，病情好转改良 Rankin 量表（mRS）评分≤2 分 11 例，1 例死亡，3 例 mRS 评分＞2 分。
结论 急性 ICAS-LVO 患者临床症状多为进展性卒中，且发病机制以低灌注/栓子清除障碍为主，急诊血管成形术治疗能使大部分患者获益，是一种安全有效的治疗手段。
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关键词】 颅内动脉粥样硬化性狭窄；大血管闭塞；血管成形术；临床特点；预后
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中图分类号】 R747.9 【
文献标识码】 A 【
文章编号】 1673-5110 （2022） 08-0969-05
基金项目：安徽医科大学校自然科学基金资助项目（编号：2021xkj207）
DOI：10.12083/SYSJ.220747 Clinical analysis of angioplasty for acute large vessel occlusion caused by intracranial atherosclerotic stenosis
CHEN Juluo，XU Jing，WANG Guofang，WANG Fuxing，WANG Youmeng
Fuyang People’s Hospital，Fuyang 236000，China
Corresponding author：WANG Youmeng
【Abstract】 Objective To analyze the clinical characteristics of patients with acute large vessel occlusion （LVO） caused by intracranial atherosclerotic stenosis （ICAS） and the prognosis of endovascular therapy. Methods Clinical data of 15 patients with ICAS-LVO admitted to Fuyang People’s Hospital from January 2020 to December 2021 were retrospectively analyzed，and the imaging characteristics，postoperative blood flow recovery，complications and clinical outcomes of 90 days were analyzed. Results Among the 15 patients，12 patients were anterior circulation and 3 were posterior circulation.The pathogenesis was artery-artery embolism in 2 cases and hypoperfusion/embolus clearance disorders in 13 cases.The clinical manifestations of 8 patients were progressive stroke，and all of them were in the late time window. All 15 patients received stent implantation after thrombectomy，and tirofiban vein was maintained for 24 hours postoperatively. After 90 days of follow-up，11 patients with modified Rankin scale （mRS） score ≤2，1 patient died，and 3 patients with mRS score>2. Conclusion The clinical symptoms of ICAS-LVO patients are mostly progressive stroke，and the pathogenesis is mainly hypoperfusion/embolic clearance disorder. Emergency angioplasty can benefit most patients，and can be a safe and effective treatment method.
【Key words】 Intracranial atherosclerotic stenosis； Large vessel occlusion； Angioplasty； Clinical characteristics；Prognosis
