重新考虑中风管理途径:在内血管治疗失败后微手术血栓切除术的作用
Markus K H Wiedmann1, Dag Ferner Netteland2, Brian Enriquez3
1Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
概括
微手术血栓切除术 (MST) 可能是急性缺血性中风 (AIS) 患者的成功救援策略,当内血管治疗 (EVT) 失败时,大血管封闭 (LVO). 在精选的病例中,迅速的MST实现了完全的血管恢复和良好的结果.
科学领域:
- 神经学 神经学
- 神经外科 神经外科
- 血管外科 血管外科
背景情况:
- 内血管治疗 (EVT) 是急性缺血性中风 (AIS) 与大血管封闭 (LVO) 的标准.
- 在10-20%的AIS患者中,EVT未能实现再通道化.
- 在EVT故障后持续的LVO需要救援策略.
研究的目的:
- 介绍微手术血栓切除术 (MST) 的案例研究,作为在AIS中EVT故障后的救援策略.
- 突出MST在复杂的LVO案件中的潜力.
- 倡导将MST纳入中风管理协议.
主要方法:
- 介绍了两例在LVO的EVT失败后MST的示例案例.
- 详细描述患者选择,手术技术和结果评估.
- 检查成像检测结果,症状出现的时间和神经状态.
主要成果:
- 在这两种情况下,通过MST实现了完整的再血管化.
- 患者在3个月内恢复到修改的兰金度量 (mRS) 0-1.
- 尽管存在诸如血管损伤或化栓塞等高风险因素,但仍取得了有利的结果.
结论:
- 微手术血栓切除术 (MST) 可以是一个安全和有效的救援选择选择AIS患者在EVT失败后持续的LVO.
- 经验丰富的团队迅速进行MST,可以在具有挑战性的情况下带来良好的功能恢复.
- 进一步的研究和MST在中风治疗途径中的结构化整合是有必要的.
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