| Background and PurposesAcute ischemic stroke(AIS)is the result of acute intracranial vascular occlusion caused by various reasons,including cerebral thrombosis and cerebral embolism,which takes up above 80% in all stokes.It is featured as high morbidity,high disability rate,high mortality and high recurrence rate.In 2008,the former ministry of health published the 3rd investigation of Chinese citizen death reasons indicated cerebral stroke had exceeded cancer as the leading cause for death in Chinese population.According to the causes of acute ischemic cerebral stroke,it’s extremely important to open the blocked vessels,recover cerebral blood flow filling and save ischemic penumbra brain tissues.At present,intravenous injection of rt-PA for thrombolysis is proven to be effective in AIS early recanalization.Due to the limited time window and strict medication indication,only 1%-2% AIS patients can benefit from that.As the progressing of interventional operation in brain vessles since new century,various interventional approaches have been applied to the treatment of AIS.From intra-arterial thrombolysis,balloon dilatation angioplasty,stent implantation,to MERCI embolectomy,Penumbra systematical embolectomy,and later self-expandable and retrievable stenting embolectomy,the time window is prolonged,vessel recanalization rate is elevated and the favorable prognosis rate is increased,which benefit more and more AIS patients.Although stent thrombectomy is superior to intravenous thrombolysis and the vessel recanalization rate reaches above 80%,the favorable prognosis is only less than 50%,which indicates vessel repass is not critical in patient prognosis.In our clinical practice and previous studies,the early arterial reocclusion after MERCI is frequently happened,making it as an important factor affecting patient prognosis.The aim of this study is to find methods to improve recanalization rate,reduce the reocclusion rate and the risk of hemorrhagic transformation in the mechanical thrombectomy of acute ischemic stroke,so as to guide the safety and individualized treatment of stroke.MethodWe innovatively incorporated stent thrombectomy with negative pressure thrombectomy,balloon dilatation or stent placement,and used high-resolution magnetic resonance to detect vascular wall changes at the site of thrombectomy:Part one: According to the inclusion criteria,we collected 42 cases of intravenous thrombolytic therapy and 68 cases of stent thrombectomy in Zhengzhou hospital from January 2013 to January 2015,compared and analyzed the recanalization rate,reocclusion rate and prognosis of patients with intravenous thrombolysis and stent thrombectomy to conduct statistical analysis.Part two: In strict accordance with the criteria for admission,the acute ischemic stroke patients admitted to Zhengzhou hospital between January 2015 and January 2017 were included.According to the vascular condition,some compound therapeutic methods such as stent thrombectomy,combined thrombus extraction,balloon dilatation,and stent implantation were applied.We evaluated the NIHSS score,intraoperative vascular recanalization,postoperative vascular recanalization and blood flow,intraoperative and postoperative hemorrhage transformation 1 hour and two weeks after admission and treatment;we followed up patients’ prognositic life quality for three months and evaluated mRS score;also,we analyzed vascular wall changes at the site of vascular thrombectomy by means of high resolution magnetic resonance.The collected clinical data were analyzed statistically.ResultPart one: Recanalization rate of intravenous thrombolysis is 14.3%,Sole Solitaire stent thrombectomy recanalization rate,82.3%,P<0.05;Good prognosis rate of intravenous thrombolysis,16.7%;Good prognosis rate of stent thrombectomy,47.1%,P<0.05;Hemorrhagic transformation rate of intravenous thrombolysis,19.1%,P>0.05;The average score of NIHSS for patients with intravenous thrombolysis admitting in the hospital,11.5±3.5;Average score of NIHSS for thrombolysis in 1 hour,10.6±4.7;The comparison of NIHSS score between admission and 1 hour after operation(P>0.05)has no statistic significance;The average discharging NIHSS score is 12.1±9.0.Comparing it with admission NIHSS score,the difference has no statistic significance.The average stent thrombectomy admission score is 13.9±5.1 and the average NIHSS score one hour after operation is 10.0±5.3 Comparing the NIHSS score between them(P<0.05),the difference has great statistic significance and the average NIHSS discharging score is 10.1±8.5(P<0.05),the difference has great statistic significance.Part two: For thrombectomy combination therapy,the vascular recanalization rate is 88.6%.Three months follow up prognosis recovery rate is 57.1% and death rate is 18.6%.The average admission NIHSS score is 14.5±5.8 and the average NIHSS score one hour after operation is 10.4±6.9.Comparing the NIHSS score between them(P<0.05),the difference has great significance.The average discharging NIHSS score is 10.6±9.8.Comparing it with admission HINSS(P<0.05),the difference has great statistic significance.The rate of re-occlusion rate of stent thrombectomy post operation combined with balloon dilatation is 50%.Comparing it with simple stent thrombectomy,P<0.05,the difference has great statistic significance.The reocclusion rate of simple stent thrombectomy was 29.4%;the reocclusion rate of combined thrombus extraction was 0%;the reocclusion rate of combined balloon dilation was 50%,and the reocclusion rate of combined stent implantation was 23.5%.Compared with the simple stent thrombectomy,the reocclusion rate of combined thrombus extraction or stent placement decreased significantly;the reocclusion rate of combined balloon dilation increased significantly,and the disability rate and mortality rate increased significantly.ConclusionThe paper validated Solitaire stent thrombectomy has obvious advantage in AIS therapy when comparing with the intravenous thrombolytic therapy such as the extended time window,obviously improved vascular recanalization rate and the improved patient prognosis.Stent thrombectomy with catheter thrombus aspiration or stent implantation lowered the reocclusion rate after dredging blocking vessels with favorable prognosis.Stent thrombectomy with balloon dilatation significantly elevated the reocculsion rate,it was closely related to vascular wall changes. |
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