血管内取栓治疗超时间窗缺血性卒中患者的临床疗效分析  

Clinical efficacy of endovascular thrombectomy in patients with ischemic stroke beyond the time window

作　　者：覃惠洵[1] 高文[1] 张皆德 王芳[1] 黄光坚 陈红[1] Qin Huixun;Gao Wen;Zhang Jiede;Wang Fang;Huang Guangjian;Chen Hong(Department of Neurology,Liuzhou People's Hospital,Liuzhou,Guangxi Zhuang Autonomous Region 545006,China)

机构地区：[1]广西壮族自治区柳州市人民医院神经内科

出　　处：《中国脑血管病杂志》2019年第10期533-538,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨血管内取栓治疗超时间窗急性前循环大血管闭塞卒中患者的临床效果。方法回顾性连续纳入2014年1月至2018年9月柳州市人民医院神经内科经血管内取栓治疗的急性前循环大血管闭塞卒中患者182例,术前经CT血管成像或MR血管成像证实存在颈内动脉或大脑中动脉闭塞。根据症状开始至股动脉穿刺时间,将182例患者分为时间窗内(≤6h)组(156例)和超时间窗(>6h)组(26例)。收集并对比分析两组患者年龄、性别、脑血管病危险因素、急诊血糖、美国国立卫生研究院卒中量表(NIHSS)评分、卒中病因分型、Alberta卒中项目早期CT(ASPECT)评分、美国介入治疗神经放射学协会/介入放射学协会(ASITN/SIR)分级、闭塞部位、静脉溶栓比例、影像学资料、手术时间节点、取栓次数、补救治疗、血管再通情况的差异,并评估两组患者的并发症及临床预后。改良脑梗死溶栓(mTICI)分级2b或3级为成功再通,90d改良Rankin量表(mRS)评分0~2分为预后良好,6分为死亡。结果(1)两组年龄、性别、高血压病、心房颤动、高脂血症、糖尿病、脑梗死病史、吸烟史、基线NIHSS评分、ASPECT评分、血糖水平、闭塞部位、ASITN/SIR0~1级的差异均无统计学意义(均P>0.05),时间窗内组患者静脉溶栓比例高于超时间窗组,组间差异有统计学意义[38.5%(60/156)比11.5%(3/26),χ^2=7.137,P=0.008]。(2)两组患者病因分型、股动脉穿刺至再通时间、取栓次数、mTICI2b^3级、补救治疗的差异均无统计学意义(均P>0.05);时间窗内组患者症状开始至影像学检查时间[146(110,229)min比307(234,349)min,Z=-5.182]、症状开始至股动脉穿刺时间[240(190,298)min比395(379,533)min,Z=-8.015]、症状开始至再通时间[329(281,388)min比492(442,567)min,Z=-6.648]均短于超时间窗组,组间差异均有统计学意义(均P<0.01)。(3)两组患者术后24h症状性颅内出血和非症状性颅内出血发生率的差异均无Objective To investigate the clinical efficacy of endovascular thrombectomy in patients with acute anterior circulation stroke with large vessel occlusion beyond the time window.Methods From January 2014 to September 2018,182 patients with acute anterior circulation stroke with large vessel occlusion and treated with endovascular thrombectomy in the Department of Neurology of Liuzhou People's Hospital were retrospectively included.Preoperative CT angiography or MR angiography confirmed the presence of internal carotid artery or middle cerebral artery occlusion.According to the symptom onset to puncture (OTP) time,patients were divided into the within time window group(OTP≤6 h,156 cases) and the beyond time window group(OTP>6 h,26 cases).Data collected and analyzed between the two groups included age,gender,cerebrovascular disease risk factors,emergency blood glucose,the United States National Institutes of Health Stroke Scale(NIHSS) score,stroke etiology classification,Alberta Stroke Program Early CT(ASPECT) score,the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale,occlusion site,intravenous thrombolysis ratio,imaging data,operation time node,number of thrombectomy,remedy treatment and recanalization.Also,complications and clinical prognosis of the two groups were evaluated.The successful recanalization was defined as modified thrombolysis in cerebral infarction (mTICI) 2b or 3.According to the 90 d modified Rankin scale (mRS) score,0 - 2 was considered as favorable outcome,and 6 was considered as death.Results (1)No significant differences were between the two groups in age,gender,hypertension,atrial fibrillation,hyperlipidemia,diabetes,history of cerebral infarction,smoking history,baseline NIHSS score,ASPECT score,blood glucose level,occlusions site and ASITN/SIR scale 0 - 1 (all P >0.05).The intravenous thrombolysis proportion in the within time window group was higher than that in the beyond time window group,and the difference was sta

关 键 词：卒中 动脉闭塞性疾病 血管内取栓治疗 超时间窗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]