目的评价Y型双支架取栓治疗急性大脑中动脉(MCA)M1段分叉部闭塞脑梗死的有效性、安全性和预后。方法回顾性分析2017年5月至2020年9月厦门大学附属中山医院采用Y型双支架取栓治疗的连续7例急性MCA-M1段分叉部闭塞脑梗死患者临床资料。采...目的评价Y型双支架取栓治疗急性大脑中动脉(MCA)M1段分叉部闭塞脑梗死的有效性、安全性和预后。方法回顾性分析2017年5月至2020年9月厦门大学附属中山医院采用Y型双支架取栓治疗的连续7例急性MCA-M1段分叉部闭塞脑梗死患者临床资料。采用改良溶栓治疗脑梗死(m TICI)血流分级评估术后血管再通情况,改良Rankin量表(mRS)评分评定术后90 d临床预后。结果6例患者经多次单支架取栓血管均未通,遂以Y型双支架取栓均1次再通,其中5例mTICI血流分级为3级,1例为2b级;1例直接双支架取栓1次再通,mTICI血流分级为3级。5例患者(5/7)术后90 d m RS评分为1~3分,2例死亡。结论采用Y型双支架取栓治疗急性MCA-M1段分叉部闭塞脑梗死1次再通率高,可缩短取栓时间,预后较好。展开更多
目的:探讨应用CT血管造影(CTA)对基底节区大脑中动脉M1段急性梗死灶侧支循环建立情况的评价效果。方法:选取本院2023年8月~2024年7月诊治的60例基底节区大脑中动脉M1段急性梗死患者,所有患者均行CTA检查与数字减影血管造影(DSA)检查评...目的:探讨应用CT血管造影(CTA)对基底节区大脑中动脉M1段急性梗死灶侧支循环建立情况的评价效果。方法:选取本院2023年8月~2024年7月诊治的60例基底节区大脑中动脉M1段急性梗死患者,所有患者均行CTA检查与数字减影血管造影(DSA)检查评价侧支循环建立情况。以DSA检查结果为金标准,分析CTA对侧支循环建立情况评价的应用效能。分析不同侧支循环情况、不同侧支血管狭窄程度的CT参数[局部脑血流量(rCBF)、局部脑血容量(rCBV)、局部平均通过时间(rMTT)、局部最大峰值时间(rTTP)]与大脑中动脉区域侧支评分系统(Tan评分)的差异性。应用Pearson分析法,分析CT参数、Tan评分与侧支循环建立情况的相关性。对患者进行预后评估,分析不同侧支循环情况下神经功能缺损程度(NIHSS评分)、日常生活能力(BI评分)的差异性。结果:DSA检查评价为侧支循环不良27例,侧支循环良好33例;CTA检查评价为侧支循环不良25例,侧支循环良好35例;CTA对侧支循环建立情况评价的准确率、敏感度、特异度、阳性预测值、阴性预测值分别为86.67%、81.48%、90.91%、88.00%、85.71%。侧支循环良好组的rCBF、rCBV大于侧支循环不良组,rMTT、rTTP短于侧支循环不良组,Tan评分高于侧支循环不良组,均P P P P P > 0.05)。侧支循环良好组的NIHSS评分低于侧支循环不良组,BI评分高于侧支循环不良组,均P Objective: To explore the evaluation effect of CT angiography (CTA) on the establishment of collateral circulation in acute infarction lesions of the M1 segment of the middle cerebral artery in the basal ganglia region. Method: Sixty patients with acute infarction of the M1 segment of the middle cerebral artery in the basal ganglia region treated in our hospital from August 2023 to July 2024 were selected. All patients underwent CTA and digital subtraction angiography (DSA) to evaluate the establishment of collateral circulation. Using DSA examination results as the gold standard, analyze the application effectiveness of CTA in evaluating the establishment of collateral circulation. Analyze the differences in CT parameters (rCBF, rCBV, rMTT, rTTP) and the middle cerebral artery regional collateral score system (Tan score) for different collateral circulation conditions and degrees of collateral vessel stenosis. Apply Pearson analysis to analyze the correlation between CT parameters, Tan score, and collateral circulation establishment. Evaluate the prognosis of patients and analyze the differences in the degree of neurological deficit (NIHSS score) and daily living ability (BI score) under different collateral circulation conditions. Result: DSA examination evaluated 27 cases of poor collateral circulation and 33 cases of good collateral circulation;CTA examination evaluated 25 cases of poor collateral circulation and 35 cases of good collateral circulation;The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CTA in evaluating the establishment of collateral circulation were 86.67%, 81.48%, 90.91%, 88.00%, and 85.71%, respectively. The rCBF and rCBV of the group with good collateral circulation were higher than those of the group with poor collateral circulation, while rMTT and rTTP were shorter than those of the group with poor collateral circulation. The Tan score was higher than that of the group with poor collateral circulation, all P P P P P > 0.05). The NIHSS score of the group with good collateral circulation was lower than that of the group with poor collateral circulation, and the BI score was higher than that of the group with poor collateral circulation, both P < 0.05. Conclusion: CTA has a high application efficiency in evaluating the establishment of collateral circulation in acute infarction of the M1 segment of the middle cerebral artery in the basal ganglia region. There is a significant correlation between CT parameters, Tan score, and collateral circulation, and poor collateral circulation indicates poor prognosis.展开更多
目的探讨球囊扩张或血管支架补救治疗对急性大脑中动脉M1段机械取栓治疗失败患者的安全性和有效性,并分析患者预后的影响因素。方法回顾性分析2014年1月至2018年6月中国人民解放军陆军军医大学第二附属医院综合卒中中心和其他19家综合...目的探讨球囊扩张或血管支架补救治疗对急性大脑中动脉M1段机械取栓治疗失败患者的安全性和有效性,并分析患者预后的影响因素。方法回顾性分析2014年1月至2018年6月中国人民解放军陆军军医大学第二附属医院综合卒中中心和其他19家综合卒中中心80例急性大脑中动脉M1段机械取栓治疗失败并行补救治疗达到闭塞血管血流改良脑梗死溶栓分级(modi?ed thrombolysis in cerebral infarction score,m TICI)≥2b级患者的临床资料,根据补救治疗方法将其分为球囊扩张组(30例)和血管支架植入组(50例)。比较两组患者90 d改良Rankin量表(modi?ed Rankin scale,m RS)评分、血管再闭塞率、症状性颅内出血发生率及死亡率,并对影响患者预后的相关因素进行多因素Logistic回归分析。结果球囊扩张组中90 d mRS评分0～2分患者占比明显高于血管支架植入组(P <0.05);两组患者血管再闭塞率、死亡率及症状性颅内出血发生率比较均无显著差异(P_均> 0.05)。多因素Logistic回归分析显示:卒中病史(OR=8.968,95%CI:1.162～69.196,P=0.035)、补救治疗方式(OR=0.243,95%CI:0.066～0.894,P=0.033)、侧支循环(OR=3.873,95%CI:1.029～14.576,P=0.045)及基线美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分(OR=0.809,95%CI:0.701～0.934,P=0.004)均为急性大脑中动脉M1段闭塞取栓失败后行补救治疗患者神经功能预后的独立危险因素(P_均<0.05)。结论机械取栓联合球囊扩张能够有效改善急性大脑中动脉M1段闭塞性缺血性脑卒中患者神经功能,并未增加手术风险,且补救治疗方式是影响患者治疗后神经功能的独立危险因素。展开更多
大脑中动脉M2段(M2 segment of middle cerebral artery, MCA-M2)是颈内动脉系统的重要分支,大脑中动脉M2段闭塞脑梗死导致的神经功能缺损对患者家庭及社会带来了沉重的负担。大脑中动脉M2段闭塞脑梗死的介入治疗目前仍存在争议。目前...大脑中动脉M2段(M2 segment of middle cerebral artery, MCA-M2)是颈内动脉系统的重要分支,大脑中动脉M2段闭塞脑梗死导致的神经功能缺损对患者家庭及社会带来了沉重的负担。大脑中动脉M2段闭塞脑梗死的介入治疗目前仍存在争议。目前有研究表明大脑中动脉M2段闭塞脑梗死血管内治疗优于传统的内科治疗。RAPID软件在急性缺血性脑卒中患者行血管内治疗的决策中提供帮助得到认可,但对于大脑中动脉M2段闭塞脑梗死的血管内治疗适应症的选择缺乏定论。本文就大脑中动脉M2段闭塞脑梗死血管内治疗疗效及Rapid软件筛选合适大脑中动脉M2段闭塞脑梗死介入治疗患者做一综述。The M2 segment of middle cerebral artery (MCA-M2) is an important branch of the internal carotid artery system. Cerebral infarction caused by M2 segment occlusion of MCA-M2 has brought a heavy burden on the family and society. The interventional treatment of M2 segment occlusion of MCA-M2 is still controversial. Current studies have shown that endovascular treatment of M2 segment occlusion of MCA-M2 is superior to traditional medical treatment. RAPID software has been recognized as a helpful tool in the decision-making of endovascular treatment for patients with acute ischemic stroke, but there is a lack of a definite conclusion on the indications for endovascular treatment of M2 segment occlusion of MCA-M2. This article reviews the efficacy of endovascular treatment of M2 segment occlusion of MCA-M2 and the selection of suitable patients for interventional treatment of M2 segment occlusion of MCA-M2 with Rapid software.展开更多
文摘目的评价Y型双支架取栓治疗急性大脑中动脉(MCA)M1段分叉部闭塞脑梗死的有效性、安全性和预后。方法回顾性分析2017年5月至2020年9月厦门大学附属中山医院采用Y型双支架取栓治疗的连续7例急性MCA-M1段分叉部闭塞脑梗死患者临床资料。采用改良溶栓治疗脑梗死(m TICI)血流分级评估术后血管再通情况,改良Rankin量表(mRS)评分评定术后90 d临床预后。结果6例患者经多次单支架取栓血管均未通,遂以Y型双支架取栓均1次再通,其中5例mTICI血流分级为3级,1例为2b级;1例直接双支架取栓1次再通,mTICI血流分级为3级。5例患者(5/7)术后90 d m RS评分为1~3分,2例死亡。结论采用Y型双支架取栓治疗急性MCA-M1段分叉部闭塞脑梗死1次再通率高,可缩短取栓时间,预后较好。
文摘目的:探讨应用CT血管造影(CTA)对基底节区大脑中动脉M1段急性梗死灶侧支循环建立情况的评价效果。方法:选取本院2023年8月~2024年7月诊治的60例基底节区大脑中动脉M1段急性梗死患者,所有患者均行CTA检查与数字减影血管造影(DSA)检查评价侧支循环建立情况。以DSA检查结果为金标准,分析CTA对侧支循环建立情况评价的应用效能。分析不同侧支循环情况、不同侧支血管狭窄程度的CT参数[局部脑血流量(rCBF)、局部脑血容量(rCBV)、局部平均通过时间(rMTT)、局部最大峰值时间(rTTP)]与大脑中动脉区域侧支评分系统(Tan评分)的差异性。应用Pearson分析法,分析CT参数、Tan评分与侧支循环建立情况的相关性。对患者进行预后评估,分析不同侧支循环情况下神经功能缺损程度(NIHSS评分)、日常生活能力(BI评分)的差异性。结果:DSA检查评价为侧支循环不良27例,侧支循环良好33例;CTA检查评价为侧支循环不良25例,侧支循环良好35例;CTA对侧支循环建立情况评价的准确率、敏感度、特异度、阳性预测值、阴性预测值分别为86.67%、81.48%、90.91%、88.00%、85.71%。侧支循环良好组的rCBF、rCBV大于侧支循环不良组,rMTT、rTTP短于侧支循环不良组,Tan评分高于侧支循环不良组,均P P P P P > 0.05)。侧支循环良好组的NIHSS评分低于侧支循环不良组,BI评分高于侧支循环不良组,均P Objective: To explore the evaluation effect of CT angiography (CTA) on the establishment of collateral circulation in acute infarction lesions of the M1 segment of the middle cerebral artery in the basal ganglia region. Method: Sixty patients with acute infarction of the M1 segment of the middle cerebral artery in the basal ganglia region treated in our hospital from August 2023 to July 2024 were selected. All patients underwent CTA and digital subtraction angiography (DSA) to evaluate the establishment of collateral circulation. Using DSA examination results as the gold standard, analyze the application effectiveness of CTA in evaluating the establishment of collateral circulation. Analyze the differences in CT parameters (rCBF, rCBV, rMTT, rTTP) and the middle cerebral artery regional collateral score system (Tan score) for different collateral circulation conditions and degrees of collateral vessel stenosis. Apply Pearson analysis to analyze the correlation between CT parameters, Tan score, and collateral circulation establishment. Evaluate the prognosis of patients and analyze the differences in the degree of neurological deficit (NIHSS score) and daily living ability (BI score) under different collateral circulation conditions. Result: DSA examination evaluated 27 cases of poor collateral circulation and 33 cases of good collateral circulation;CTA examination evaluated 25 cases of poor collateral circulation and 35 cases of good collateral circulation;The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CTA in evaluating the establishment of collateral circulation were 86.67%, 81.48%, 90.91%, 88.00%, and 85.71%, respectively. The rCBF and rCBV of the group with good collateral circulation were higher than those of the group with poor collateral circulation, while rMTT and rTTP were shorter than those of the group with poor collateral circulation. The Tan score was higher than that of the group with poor collateral circulation, all P P P P P > 0.05). The NIHSS score of the group with good collateral circulation was lower than that of the group with poor collateral circulation, and the BI score was higher than that of the group with poor collateral circulation, both P < 0.05. Conclusion: CTA has a high application efficiency in evaluating the establishment of collateral circulation in acute infarction of the M1 segment of the middle cerebral artery in the basal ganglia region. There is a significant correlation between CT parameters, Tan score, and collateral circulation, and poor collateral circulation indicates poor prognosis.
文摘目的探讨球囊扩张或血管支架补救治疗对急性大脑中动脉M1段机械取栓治疗失败患者的安全性和有效性,并分析患者预后的影响因素。方法回顾性分析2014年1月至2018年6月中国人民解放军陆军军医大学第二附属医院综合卒中中心和其他19家综合卒中中心80例急性大脑中动脉M1段机械取栓治疗失败并行补救治疗达到闭塞血管血流改良脑梗死溶栓分级(modi?ed thrombolysis in cerebral infarction score,m TICI)≥2b级患者的临床资料,根据补救治疗方法将其分为球囊扩张组(30例)和血管支架植入组(50例)。比较两组患者90 d改良Rankin量表(modi?ed Rankin scale,m RS)评分、血管再闭塞率、症状性颅内出血发生率及死亡率,并对影响患者预后的相关因素进行多因素Logistic回归分析。结果球囊扩张组中90 d mRS评分0～2分患者占比明显高于血管支架植入组(P <0.05);两组患者血管再闭塞率、死亡率及症状性颅内出血发生率比较均无显著差异(P_均> 0.05)。多因素Logistic回归分析显示:卒中病史(OR=8.968,95%CI:1.162～69.196,P=0.035)、补救治疗方式(OR=0.243,95%CI:0.066～0.894,P=0.033)、侧支循环(OR=3.873,95%CI:1.029～14.576,P=0.045)及基线美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分(OR=0.809,95%CI:0.701～0.934,P=0.004)均为急性大脑中动脉M1段闭塞取栓失败后行补救治疗患者神经功能预后的独立危险因素(P_均<0.05)。结论机械取栓联合球囊扩张能够有效改善急性大脑中动脉M1段闭塞性缺血性脑卒中患者神经功能,并未增加手术风险,且补救治疗方式是影响患者治疗后神经功能的独立危险因素。
文摘大脑中动脉M2段(M2 segment of middle cerebral artery, MCA-M2)是颈内动脉系统的重要分支,大脑中动脉M2段闭塞脑梗死导致的神经功能缺损对患者家庭及社会带来了沉重的负担。大脑中动脉M2段闭塞脑梗死的介入治疗目前仍存在争议。目前有研究表明大脑中动脉M2段闭塞脑梗死血管内治疗优于传统的内科治疗。RAPID软件在急性缺血性脑卒中患者行血管内治疗的决策中提供帮助得到认可,但对于大脑中动脉M2段闭塞脑梗死的血管内治疗适应症的选择缺乏定论。本文就大脑中动脉M2段闭塞脑梗死血管内治疗疗效及Rapid软件筛选合适大脑中动脉M2段闭塞脑梗死介入治疗患者做一综述。The M2 segment of middle cerebral artery (MCA-M2) is an important branch of the internal carotid artery system. Cerebral infarction caused by M2 segment occlusion of MCA-M2 has brought a heavy burden on the family and society. The interventional treatment of M2 segment occlusion of MCA-M2 is still controversial. Current studies have shown that endovascular treatment of M2 segment occlusion of MCA-M2 is superior to traditional medical treatment. RAPID software has been recognized as a helpful tool in the decision-making of endovascular treatment for patients with acute ischemic stroke, but there is a lack of a definite conclusion on the indications for endovascular treatment of M2 segment occlusion of MCA-M2. This article reviews the efficacy of endovascular treatment of M2 segment occlusion of MCA-M2 and the selection of suitable patients for interventional treatment of M2 segment occlusion of MCA-M2 with Rapid software.
