急性缺血性卒中血管内机械取栓单中心临床研究  

A single-center study on endovascular thrombectomy for acute ischemic stroke

作　　者：张广[1] 季智勇[1] 史怀璋[1] 徐善才[1] 亓敬涛[1] 朱仕逸 周配权[1] 

机构地区：[1]哈尔滨医科大学附属第一医院神经外科,150001

出　　处：《中国现代神经疾病杂志》2017年第11期800-805,共6页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：吴阶平医学基金会临床科研专项课题(项目编号:320.6750.12189)~~

摘　　要：目的探讨血管内机械取栓治疗大血管闭塞致急性缺血性卒中的有效性和安全性。方法共41例大血管闭塞致急性缺血性卒中患者采用血管内机械取栓治疗,记录发病至入院时间、入院至股动脉穿刺时间、发病至血管再通时间,术后即刻采用改良脑梗死溶栓血流分级(mTICI)评价血管再通情况,术后24 h采用美国国立卫生研究院卒中量表(NIHSS)评价神经功能,术后90 d采用改良Rankin量表(mRS)评价临床预后;记录围手术期血管内机械取栓相关并发症,术后90 d症状性颅内出血发生率和病死率;采用美国介入和治疗性神经放射学学会/美国介入放射学学会侧支循环分级系统评价前循环侧支代偿,BATMAN评分标准评价后循环侧支代偿。结果 41例患者中12例(29.27%)行静脉溶栓桥接血管内机械取栓。32例(78.05%)术后即刻实现血管再通(mTICI 2b^3级),前循环再通20例(80%,20/25)、后循环再通12例(12/16),组间差异无统计学意义(校正χ~2=1.424,P=0.706);28例(68.29%)术后24 h神经功能改善(NIHSS评分下降≥4分),前循环闭塞18例(72%,18/25)、后循环闭塞10例(10/16),组间差异无统计学意义(χ~2=0.407,P=0.524);11例(26.83%)术后90 d内死亡,前循环闭塞4例(16%,4/25)、后循环闭塞7例(7/16),组间差异无统计学意义(校正χ~2=2.130,P=0.144),3例死于并发肺部感染和呼吸功能衰竭、8例死于缺血性卒中;14例(34.15%)预后良好(mRS评分≤2分),前循环闭塞10例(47.62%,10/21)、后循环闭塞4例(4/9),组间差异无统计学意义(校正χ~2=0.493,P=0.483);6例(14.63%)发生症状性颅内出血,前循环闭塞4例(16%,4/25)、后循环闭塞2例(2/16),组间差异无统计学意义(校正χ~2=3.303,P=0.856)。33例行侧支代偿评价,20例前循环闭塞患者中14例(70%)侧支代偿良好,其中9例(9/14)术后90 d预后良好,6例(30%)侧支代偿欠佳均预后不良,组间差异有统计学意义(Fisher确切概率法:P=0.014);13例后循环闭塞患者中3例(3/1Objective To evaluate the efficiency and safety of endovascular thrombectomy for acute ischemic stroke caused by acute large vessel occulsion. Methods A total of 41 patients with acute ischemic stroke caused by acute large vessel occulsion were treated with endovascular thrombectomy. Time from onset to admission, from admission to femoral artery puncture, from onset to recanalization were recorded. Modified Thrombolysis in Cerebral Infarction（mTICI） was used to assess the recanalization immediately after operation. National Institutes of Health Stroke Scale（NIHSS） was used to evaluate the neurological function at 24 h after operation. Modified Rankin Scale（mRS） was used to evaluate clinical prognosis at 90 d after operation. Perioperative procedure.related complications and occurrence rate ofsymptomatic intracranial hemorrhage within at 90 d after operation were recorded. American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology（ASITN/SIR） Collateral Flow Grading System（ACG） was used to assess collateral compensation of anterior circulation. BATMAN score was used to assess collateral compensation of posterior circulation. Results Among 41 patients, 12（29.27%） were treated with recombinant tissue.type plasminogen activator（rt.PA） intravenous thrombolysis.There were 32 patients（78.05%） achieved successful recanalization, including 20 patients（80%, 20/25） in anterior circulation and 12（12/16） in posterior circulation, and no significant difference was seen between them（adjusted χ^2=1.424, P=0.706）. At 24 h after operation, 28 patients（68.29%） had better neurological function than preoperation（NIHSS decreasing ≥ 4 score）, including 18 patients（72%, 18/25） with anterior circulation occlusion and 10（10/16） with posterior circulation occlusion, and there was no significant difference between them（χ^2=0.407, P=0.524）. Eleven patients（26.83%） died within 90 d after operation,including 4 patients（16%, 4/25�

关 键 词：卒中 脑缺血 血栓切除术 血管造影术 数字减影 

分 类 号：R743.3[医药卫生—神经病学与精神病学]