Interventional Treatment Of Acute Intracranial Artery Occlusion:Three Cases Reports And A Review Of The Literature

Objective:To investigate the operative indication, opportunity, complication and related drug usage in patients with acute intracranial artery occlusion, who received the treating of mechanical fragmentation by micro-guide wire and percutaneous endovascular angioplasty (PTA) and intravascular stent placement without any intravascular thrombolytic drug in their recovery period, so as to give a further guidance on interventional treatment of patients with acute intracranial artery occlusion.Methods:By retrospective analysis of three cases of intracranial artery occlusion(two cases of internal carotid artery initial segment, and one case of vertebral artery intracranial segment) recovery period in patients with cerebral vascular digital silhouette angiography(DSA), we evaluated the feasibility and fatalness of interventional treatment for them, including mechanical fragmentation by micro-guide wire, PTA and intravascular stent placement. We reviewed interrelated foreign and domestic literatures, and gave a systematic exposition of the operative indication, opportunity, complication and related drug usage in patients with acute intracranial artery occlusion and recanalization.Results3patients were all received cerebral DSA, and were discovered complete occlusion for their responsible vessels. We used the micro-guide wire to make the occlusive vascular recanalization separately, and then gave the PTA treatment. One case of vertebral artery intracranial segment occlusion received the intravascular stent placement instantly after the PTA, and the other two cases with internal carotid artery initial segment occlusion took the anti-freezing and dual antiplatelet treatment for7days before they received the intravascular stent placement. One of them was discovered the reocclusion at the place of recanalization before the intravascular stent placement, and the other one were discovered that blood flow and good vascular filling without restenosis and reocclusion after PTA. The occlusive vessels in3cases were all recanalizated immediately without complications during and after the intravascular stent placement. The patients were given hypodermic injection of low molecular heparin5000iu q12h for at least3-5days, combined with Aspirin and Plavix for at least3-6months. During the following1,3and9months, the clinical symptoms of all3patients improved significantly, and uncomfortable symptoms associated with treatment were not found. The injured neural function in one case of the patients with internal carotid artery occlusion was almost recovered, and the clinical symptoms of the other two patients also greatly improved. The judgment indicators we used to evaluate the recovery of the neurological function include: physical function, linguistic function and consciousness.Conclusion:For patients with cerebral vascular occlusion who are in their recovery period, when retrograde flood imaging in the distal of occlusive vessels during the cerebral DSA, we can give the treatment of mechanical fragmentation by the micro-guide wire、PTA and intravascular stent placement to make the occlusion reanalyzed. The method is clinically proved to be feasible and its long term effect and safety is worth being deeply proved in the following clinical practice.