摘要目的 观察使用“Y”形双支架取栓术治疗急性颈内动脉末端T形分叉闭塞的可行性和有效性.方法 2013年9月至2015年4月第二军医大学附属长海医院脑血管病中心采用“Y”形双支架取栓术治疗7例心源性栓塞导致的急性颈内动脉末端闭塞患者.所有患者大脑中动脉闭塞使用Solitaire支架,大脑前动脉闭塞使用Revive支架.结果 6例(6/7)取栓后再通成功,改良脑梗死溶栓分级(mTICI)达到2b～3级,其中5例为完全再通(mTICI 3级);1例未成功,mTICI为2a级.穿刺到再通时间为38 ～97 min,平均(57.1 ±21.6)min.术中出现新发栓塞1例,颅内占位性血肿1例,术后死于肺部感染1例.随访3个月期间无新发卒中、短暂性脑缺血发作及死亡事件,无再次闭塞发生.结论 使用双支架取栓技术治疗急性颈内动脉末端“T”形分叉闭塞安全可行,血管再通比例较高.

abstractsObjective To observe the feasibility and effectiveness of Y-double stent-retriever thrombectomy for terminal acute internal carotid artery T occlusion.Methods From September 2013 to April 2015,7 patients with cardioembolism caused distal end occlusion of acute internal carotid artery were treated with double-Y stent-retriever thrombectomy at the Center of Cerebrovascular Diseases,Shanghai Changhai Hospital,the Second Military Medical University.All patients with middle cerebral artery occlusion were treated with the Revive stents.Results After thrombectomy,6 patients (6/7) achieved recanalization successfully.The modified Thrombolysis in Cerebral Infarction (mTICI) grade achieved grade 2 b-3,5 of them were recanalized completely (mTICI grade 3);1 was grade 2a.The time from puncture to recanalization was 38-97 min (mean 57.1 ± 21.6 min).One patient had a new thrombosis,1 had intracranial space-occupying hematoma,and 1 died of pulmonary infection after procedure.No new stroke,transient ischemic attack,death event,and re-occlusion occurred during the 3-month follow-up period.Conclusion The use of double stent-retriever thrombectomy technique for the treatment of terminal acute internal carotid artery T occlusion is safe and feasible,and the vascular recanalization rate is higher.