摘要目的:初步观察血管内机械取栓治疗Alberta卒中项目早期CT评分(ASPECTS)<6分的急性前循环大血管闭塞性卒中的安全性和有效性。方法:回顾性分析2015年7月至2020年1月北京医院神经外科采用血管内机械取栓治疗的30例ASPECTS<6分的急性前循环大血管闭塞性卒中患者的临床资料。30例患者的术前美国国立卫生研究院卒中量表(NIHSS)评分中位数(范围)为17(7～37)分，ASPECTS为(3.8±1.0)分。头颅数字减影血管造影(DSA)检查显示，大脑中动脉闭塞13例(其中M1段闭塞11例，M2段闭塞2例)，颈内动脉闭塞13例，颈内动脉与大脑中动脉串联闭塞病变4例。采用改良脑梗死溶栓(mTICI)分级对术后即刻血管再通情况进行评估，以mTICI分级2b或3级作为血管成功再通标准。根据欧洲急性卒中协作研究Ⅱ中的标准对出血转化进行分类，观察Ⅱ型脑实质血肿的发生率，用以评价血管内治疗的安全性。术后90 d通过门诊或电话进行随访，定义改良Rankin量表评分0～2分为神经功能预后良好，3～6分为预后不良。结果:30例患者中，24例(80.0%)血管成功再通，术后2例(6.7%)发生Ⅱ型脑实质血肿。术后90 d行临床随访，33.3%(10/30)的患者获得良好临床预后，其中成功再通组9例(9/24，37.5%)，未成功再通组1例(1/6)；10例患者(10/30，33.3%)死亡，其中成功再通组7例(7/24，29.2%)，未成功再通组3例(3/6)。基线ASPECTS 3～5分的患者中，获得良好神经功能预后者占37.0%(10/27)，病死率为25.9% (7/27)；基线ASPECTS 0～2分的患者中，获得良好神经功能预后者占比为0/3，病死比例为3/3。结论:初步观察发现，对于基线ASPECTS 3～5分的急性前循环大血管闭塞性卒中患者，行血管内机械取栓治疗仍可能是安全有效的；但基线ASPECTS 0～2分的患者行血管内机械取栓治疗预后仍差。

abstractsObjective:To explore the safety and efficacy of endovascular mechanical thrombectomy in treatment of acute anterior circulation large vessel occlusive stroke (AACLVOS) of patients with the Alberta Stroke Program Early CT Score (ASPECTS) <6.Methods:A retrospective study was conducted on the clinical data of a total of 30 patients with AACLVOS and baseline ASPECTS <6 who underwent mechanical thrombectomy at Department of Neurosurgery, Beijing Hospital from July 2015 to January 2020. The median preoperative National Institute of Health stroke scale (NIHSS) score was 17 (range: 7-37), and the average ASPECTS was 3.8±1.0. Preoperative DSA demonstrated that the occlusion sites were MCA in 13 cases (M1 segment in 11 cases and M2 segment in 2), ICA in 13 cases, and tandem occlusion of ICA and MCA in 4 cases. Successful recanalization was defined by a modified thrombolysis in cerebral infarction (mTICI) score of 2b-3 assessed at the end of the procedure. Hemorrhagic transformation was graded according to the European Cooperative Acute Stroke Study Ⅱ, and the safety of endovascular treatment was evaluated according to the incidence of type Ⅱ parenchymal hematoma. Follow-up was conducted at 90 days post operation through outpatient clinic visits or telephone enquiry, and a favorable neurological outcome was defined as an mRS (modified Rankin scale) score of 0-2, while a poor outcome was defined as an mRS score of 3-6.Results:Successful recanalization was achieved in 24 patients (24/30, 80.0%). Two patients (2/30, 6.7%) had type Ⅱ parenchymal hematomas after the procedure. At 90-day clinical follow-up, ten patients (10/30, 33.3%) achieved favorable outcomes, including 9 re-perfused patients (9/24, 37.5%) and 1 non-perfused patient (1/6). Ten patients (10/30, 33.3%) died, including 7 re-perfused patients (7/24, 29.2%) and 3 non-perfused patients (3/6). For patients with baseline ASPECTS of 3-5, the rate of 90-day favorable outcome was 37.0% (10/27)and the mortality rate was 25.9% (7/27). For patients with baseline ASPECTS of 0-2, the proportion of favorable outcome was 0/3 and the mortality rate was 3/3.Conclusion:Preliminary observational study has demonstrated that mechanical thrombectomy in patients with AACLVOS and baseline ASPECTS of 3-5 may be relatively safe and effective, while the outcome may remain poor in those with baseline ASPECTS of 0-2.