Therapeutic effect of thrombectomy for acute middle cerebral artery M2 segment occlusion: A preliminary analysis / 中国脑血管病杂志

ABSTRACT

Objective To preliminarily discuss the effect and safety of stent thrombectomy for acute middle cerebral artery M2 segment occlusion in patients with ischemic stroke. Methods From January 2014 to February 2019,19 consecutive acute ischemic stroke patients with acute middle cerebral artery M2 segment occlusion registered in Stroke Database of General Hospital of Eastern War Zone were enrolled retrospectively. They all receive stent thrombectomy. Of Lhe 19 patients, 12 were male and 7 were female;the age ranged from 48 to 83 years,with a median age of 69 ( 51,75) years;9 patients also had atrial fibrillation, 15 had hypertension,6 had diabetes,and 4had a history of coronary heart disease,and 2 had a history of stroke (the pre-onset modified Rankin scale [MRS] score 1) ;8 had a history of smoking;the National Institutes of Health Stroke Scale (NIHSS) scores on admission were 5 to 28,and the median score was 15 ( 11,22) ;the early CT scores (ASPECTS) of the Alberta Stroke Project were 3-10,and the median score was 8 (6,9);according to the etiological typing of Trial of Org 10172 in Acute Stroke Treatment (TOAST) ,9 were large atherosclerosis and 10 were cardiac embolism The NIHSS scores before and after thrombectomy, surgical methods, recanalization, and intracranial hemorrhage were analyzed, and the prognosis at 90 d after surgery was analyzed. The modified Thrombolysis in Cerebrovascular Infarction (mTICI) grade (mTICI) 2b-3 were successful recanalization; the MRS scores 0 -2 were clinical good prognosis, and the MRS scores 3 -6 were poor prognosis. Results The time from onset to puncture in 19 patients was 137-545min,a median time was 265 (184,347) min,and the time from puncture to recanalization was 75 (58,98) min;17 patients only used stent thrombectomy and 2 were also treated with a balloon recanalization. The median number of thrombectomy was 1 ( 1 ,2) times;the proportion of successful recanalization was 16/19, and 3 patients were mTICI grade 2a. The NIHSS scores were 1 to 30 at 24 h after surgery,and the median score was 17 (4,21). The NIHSS scores were 1 - 30 at discharge and the median score was 11 (2,15). Seven patients occurred intracranial hemorrhage, 1 of them was symptomatic intracranial hemorrhage; the other 12 did not have intracranial hemorrhage. Three of 19 patients died during the follow-up at 90d,including 1 herniation of brain, 1 diabetic nephropathy caused renal insufficiency,and 1 cerebral hemorrhage. The median MRS score was 2 (1,4) ,and the proportion of the good prognosis was 11/19 (including 10 successful recanalists) ,and the proportion of the poor prognosis was 8/19 (including 6 successful recanalists). Conclusion Preliminary analysis of the effect of stent thrombectomy in ischemic stroke patients with acute middle cerebral artery M2 segment occlusion is considered safe and effective, but the conclusion needs further verification.