[1]黄晨阳,刘廷钰,朱青峰.症状性非急性期大脑中动脉M2段闭塞血管内再通：附1例报道并文献复习[J].中国临床神经外科杂志,2024,29(06):341-346.[doi:10.13798/j.issn.1009-153X.2024.06.005]
　HUANG Chen-yang,LIU Ting-yu,ZHU Qing-feng.Efficacy of endovascular recanalization for symptomatic non-acute occlusion of the M2 segment of the middle cerebral artery: a case report and literature review[J].,2024,29(06):341-346.[doi:10.13798/j.issn.1009-153X.2024.06.005]
点击复制

症状性非急性期大脑中动脉M2段闭塞血管内再通：附1例报道并文献复习()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
29
期数:
2024年06期
页码:
341-346
栏目:
论著
出版日期:
2024-06-30

文章信息/Info

Title:
Efficacy of endovascular recanalization for symptomatic non-acute occlusion of the M2 segment of the middle cerebral artery: a case report and literature review
文章编号:
1009-153X（2024）06-0341-06
作者:
黄晨阳; 刘廷钰; 朱青峰
030001太原，山西医科大学研究生院（黄晨阳、刘廷钰）；030001太原，山西医科大学第二医院神经外科（朱青峰）
Author(s):
HUANG Chen-yang1;  LIU Ting-yu1;  ZHU Qing-feng2
1. Graduate School, Shanxi Medical University, Taiyuan 030001, China; 2. Department of Neurosurgery, Second Hospital of Shanxi Medical University, Taiyuan 030001, China
关键词:
颅内血管闭塞; 大脑中动脉; 非急性期; 血管内治疗; 疗效
Keywords:
Cerebral vessel occlusion;  Middle cerebral artery;  Non-acute phase;  Endovascular treatment;  Efficacy
分类号:
R 743; R 815.2
DOI:
10.13798/j.issn.1009-153X.2024.06.005
文献标志码:
A
摘要:
目的 探讨症状性非急性期大脑中动脉M2段闭塞的临床特征、血管内治疗的方法及其疗效。方法 回顾性分析采用血管内介入治疗的1例症状性非急性期大脑中动脉M2段闭塞的临床资料，并结合相关文献进行分析。结果 65岁男性，高血压病史13年余，未规律服用降血压药物；因急性脑梗死溶栓治疗后复发1周入院，左侧肢体肌力0级，NIHSS评分18分，mRS评分5分。头颅MRI示右侧大脑半球多发梗死灶，头颅CTA显示右侧大脑中动脉闭塞，脑灌注成像示右侧大脑半球明显低灌注；全脑血管造影示右侧大脑中动脉上干、下干闭塞，大脑前动脉软膜支、大脑后动脉软膜支向大脑中动脉供血区域有部分代偿。完善术前准备后，行右侧大脑中动脉上干（M2段）血管内再通治疗。术后立即复查头颅CT未见颅内出血；术后1个月，左下肢肌力5级，左上肢肌力3级，mRS评分2分。术后3年随访，左下肢肌力5级，左上肢肌力4级，mRS评分1分。结论 对于大脑中动脉M2段非急性期闭塞病人，如果症状较重，在充分术前评估后，可以尝试进行血管内再通治疗。
Abstract:
Objective To investigate the clinical features, and endovascular treatment methods and outcomes of patients with symptomatic non-acute occlusion of the M2 segment of the middle cerebral artery (MCA). Methods The clinical data of one patient with symptomatic non-acute occlusion of the M2 segment of the MCA treated with endovascular recanalization was retrospectively analyzed, and the related literatures were recovered. Results A 65-year-old male with a history of hypertension for over 13 years and no regular use of antihypertensive drugs presented with recurrent acute cerebral infarction one week after thrombolytic therapy for the initial infarction. He had a motor power of 0 on the left side, an NIHSS score of 18, and an mRS score of 5 on admission. Head MRI showed multiple infarction lesions in the right cerebral hemisphere, head CTA showed occlusion of the right MCA, and cerebral perfusion imaging showed marked hypoperfusion in the right cerebral hemisphere. The angiography showed that the superficial and deep branches of the right MCA were occluded, while the pia mater branches of the anterior and posterior cerebral arteries supplied the territory of the MCA partially. After completing preoperative evaluation, endovascular recanalization of the M2 segment of the right MCA was performed. No intracranial hemorrhage was detected on immediate postoperative head CT. One month after the operation, the left lower limb had a motor power of 5, the left upper limb had a motor power of 3, and the mRS score was 2. Three years after the operation, the left lower limb had a motor power of 5, the left upper limb had a motor power of 4, and the mRS score was 1. Conclusions For patients with non-acute occlusion of the M2 segment of the MCA associated with severe symptoms, endovascular recanalization can be considered after thorough preoperative evaluation.

参考文献/References:

[1]ZHU QF, WANG GF, SUN Q, et al. Clinical effect of mechanical thrombectomy for acute cerebral infarction caused by relatively small blood vessel occlusion[J]. Clin Med Chin, 2018, 34(6): 511-516.朱青峰，王国芳，孙　奇，等. 相对小血管闭塞致急性脑梗死机械取栓临床效果观察[J]. 中国综合临床，2018，34（6）：511-516.
[2]KIM YW, SON S, KANG DH, et al. Endovascular thrombectomy for M2 occlusions: comparison between forced arterial suction thrombectomy and stent retriever thrombectomy[J]. J Neurointerv Surg,2017, 9(7): 626-630.
[3]CHO YH, CHOI JH，CHO YH, et al. Mechanical thrombectomy for acute ischemic stroke with occlusion of the M2 segment of the middle cerebral artery: a literature review[J]. J Cerebrovasc Endovasc Neurosurg, 2021, 23(3): 193-200.
[4]ATCHANEEYASAKUI K, MALIK AM, YAVAGAL DR, et al. Thrombectomy outcomes in acute ischemic stroke due to middle cerebral artery M2 occlusion with stent retriever versus aspiration: a multicenter experience[J]. Interv Neurol, 2020, 8(2-6): 180-186.
[5]HUO XC, GAO F. Endovascular treatment of acute ischemic stroke China guide 2018[J]. Chin J Stroke, 2018, 13(7): 706-729.霍晓川，高　峰. 急性缺血性卒中血管内治疗中国指南2018[J].中国卒中杂志，2018，13（7）：706-729.
[6]CHEN KN, WGF YL. 2018 Chinese expert consensus on endovascular treatment of symptomatic atherosclerotic non-acute intracranial large artery occlusion[J]. Chin J Stroke, 2018, 13(11): 1166-1181.陈康宁，王伊龙. 2018症状性动脉粥样硬化性非急性颅内大动脉闭塞血管内治疗中国专家共识[J]. 中国卒中杂志，2018，13（11）：1166-1181.
[7]LIU X F, MENG J, ZHU QF. Symptomatic of acute intracranialartery occlusion endovascular recanalization treatment of preoperative evaluation research progress[J]. Chin Med Clinic, 2021, 21 (17): 2951-2954.刘晓峰，孟　杰，朱青峰. 症状性非急性颅内大动脉闭塞血管内再通治疗术前评估研究进展[J]. 中国药物与临床，2021，21（17）：2951-2954.
[8]ZHU QF, SUN Q, BAI YW. Current status and prospect of treatment of non-acute intracranial large artery occlusion[J]. Chin J General Clinic, 2021, 37(4): 370-375.朱青峰，孙　奇，白永文. 非急性期颅内大动脉闭塞治疗现状与展望[J]. 中国综合临床，2021，37（4）：370-375.
[9]ZHENG JZ, ZHEN Z, GAO YH, et al. Symptomatic of acute middle cerebral artery occlusion endovascular recanalization treatment effect of preliminary analysis[J]. Chin J Cerebrovasc Dis, 2021, 18(1): 43-48.郑　进，张震中，高宇海，等. 症状性非急性大脑中动脉闭塞血管内再通治疗效果的初步分析[J]. 中国脑血管病杂志，2021，18（1）：43-48.
[10]GAO F, GUO X, HAN J, et al. Endovascular recanalization for symptomatic non-acute middle cerebral artery occlusion: proposal of a new angiographic classification[J]. J Neurointerv Surg, 2021, 13(10): 900-905.
[11]AGHAEBRAHIM A, JOVIN T, JADHAV AP, et al. Endovascularrecanalization of complete subacute to chronic atherosclerotic occlusions of intracranial arteries[J]. J Neurointerv Surg, 2014, 6(9):645-648.
[12]ZHANG C, ZHAO S, ZANG Y, et al. The efficacy and safety of Dl-3n-butylphthalide on progressive cerebral infarction: a randomized controlled STROBE study[J]. Medicine, 2017, 96(30): e7257.
[13]CHOU CW, CHANG JH, LIN SZ, et al. Extracranial-intracranial (EC-IC) bypass of symptomatic middle cerebral artery (MCA) total occlusion for haemodynamic impairment patients[J]. Br J Neurosurg, 2012, 26(6): 823-826.
[14]LOW SW, TEO K, LWIN S, et al. Improvement in cerebral hemodynamic parameters and outcomes after superficial temporal artery-middle cerebral artery bypass in patients with severe stenoocclusive disease of the intracranial internal carotid or middle cerebral arteries[J]. J Neurosurg, 2015, 123(3): 662-669.
[15]TEO KAC, YEO TT, SHARMA KV. Long-term outcome in extracranial intracranial bypass surgery for severe steno-occlusive disease of intracranial internal carotid or middle cerebral artery[J]. Clin Neurol Neurosurg, 2018, 169: 149-153.
[16]MORI T, MORI K, FUKUOKA M, et al. Percutaneous transluminal angioplasty for total occlusion of middle cerebral arteries[J]. Neuroradiology, 1997, 39(1): 71-74.
[17]ZHENG M, SONG Y, ZHANG J, et al. Endovascular recanalization of non-acute symptomatic middle cerebral artery total occlusion and its short-term outcomes[J]. Front Neurol, 2019, 10（5): 484.
[18]MA L, LIU YH, FENG H, et al. Endovascular recanalization for symptomatic subacute and chronic intracranial large artery occlusion of the anterior circulation: initial experience and technical considerations[J]. Neuroradiology, 2019, 61(7): 833-842.
[19]HUANG R, LAI X L, XIONG YY, et al. Advances in endovascular recanalization of symptomatic non-acute middle cerebral artery occlusion[J]. Chin J Nerv Ment Dis, 2021, 47(3): 178-182.黄　锐，赖贤良，熊元元，等. 症状性非急性期大脑中动脉闭塞血管内再通治疗研究进展[J]. 中国神经精神疾病杂志，2021，47（3）：178-182.
[20]LI XZ, YAN WT, GUO S, et al. Recanalization of symptomatic non-acute middle cerebral artery occlusion[J]. Chin J Contemp Neurol Neurosurg, 2020, 20(6): 512-518.李修珍，闫文涛，郭　姗，等. 症状性非急性大脑中动脉闭塞血管再通治疗研究[J]. 中国现代神经疾病杂志，2020，20（6）：512-518.
[21]CHEN K, HOU X, ZHOU Z, et al. The efficacy and safety of endovascular recanalization of occluded large cerebral arteries during the subacute phase of cerebral infarction: a case series report[J]. Stroke Vasc Neurol, 2017, 2(3): 124-131.
[22]WAN Y, LO WT, LIU YX, et al. Endovascular revascularization of symptomatic chronic middle cerebral artery occlusions：two case reports[J]. Intervent Neuroradiol, 2016, 22（1): 84-87.
[23]PADALIA A, SAMBURSKY JA, SKINNER C, et al. Percutaneous transluminal angioplasty with stent placement versus best medical therapy alone in symptomatic intracranial arterial stenosis: a best evidence review[J]. Cureus, 2018, 10(7): e2988.
[24]LEE JS, HONG JM, LEE KS, et al. Primary stent retrieval for acute intracranial large artery occlusion due to atherosclerotic disease[J].J Stroke, 2016, 18(1): 96-101.

相似文献/References:

[1]李文超　周文科　赵锦丽　黄立勇　恵　磊　高国军　王　磊　金保哲.大脑中动脉动脉瘤夹闭术中电生理监测的意义[J].中国临床神经外科杂志,2018,(06):405.[doi:10.13798/j.issn.1009-153X.2018.06.007]
　LI Wen-Chao,ZHOU Wen-Ke,ZHAO Jin-Li,et al.Electrophysiological monitoring during intraoperative occlusion of middle cerebral artery aneurysms[J].,2018,(06):405.[doi:10.13798/j.issn.1009-153X.2018.06.007]
[2]陈　虎　邓剑平　于　嘉　张　涛　刘宇峰　赵振伟.急性颅内大动脉粥样硬化性狭窄继发闭塞与单纯栓塞性闭塞的血管内治疗分析[J].中国临床神经外科杂志,2020,(02):70.[doi:10.13798/j.issn.1009-153X.2020.02.003]
　CHEN Hu,DENG Jian-ping,YU Jia,et al.Clinical characteristics of acute intracranial large artery atherosclerosis-related occlusion and effects of endovascular treatment: a comparison with intracranial artery thromboembolic occlusion[J].,2020,(06):70.[doi:10.13798/j.issn.1009-153X.2020.02.003]
[3]张果,秦小宏,程荆,等.脑血运重建术治疗成人脑底异常血管网病的疗效分析[J].中国临床神经外科杂志,2023,28(02):65.[doi:10.13798/j.issn.1009-153X.2023.02.001]
　ZHANG Guo,QIN Xiao-hong,CHEN Jin,et al.Short-term efficacy of STA-MCA bypass combined with ence-phalo-myo-synangiosis for adult moyamoya diseases: single-vessel bypass vs. double-vessel bypass[J].,2023,28(06):65.[doi:10.13798/j.issn.1009-153X.2023.02.001]
[4]张莹,罗斌,康慧斌,等.Pipeline栓塞装置治疗大脑中动脉动脉瘤的疗效：一项回顾性多中心研究[J].中国临床神经外科杂志,2023,28(04):225.[doi:10.13798/j.issn.1009-153X.2023.04.001]
　ZHANG Ying,LUO Bin,KANG Hui-bin,et al.Clinical efficacy of pipeline embolization devices for patients with middle cerebral artery aneurysms: a retrospective multicenter study[J].,2023,28(06):225.[doi:10.13798/j.issn.1009-153X.2023.04.001]

备注/Memo

备注/Memo:
（2022-03-17收稿，2024-03-15修回）
基金项目：山西省重点研发计划项目（社会发展方面）（201603D321061）
通信作者：朱青峰，Email：zhuqingfengvip@163.com
更新日期/Last Update: 2024-06-30