房颤合并急性颅内大动脉闭塞患者的临床特点及机械取栓疗效分析  

Endovascular thrombectomy in patients with intracranial large artery occlusion and atrial fibrillation

作　　者：张宝瑞 刘爱华[1] 莫大鹏[2] 霍晓川[2] 刘鹏[1] 金恒伟 缪中荣[2] Zhang Baorui;Liu Aihua;Mo Dapeng;Huo Xiaochuan;Liu Peng;Jin Hengwei;Miao Zhongrong(Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Department of Interventional Neuroradiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]北京市神经外科研究所,北京100070 [2]首都医科大学附属北京天坛医院神经介入中心,北京100070

出　　处：《中华医学杂志》2019年第39期3068-3072,共5页National Medical Journal of China

基　　金：国家重点研发计划(2016YF1301500);国家自然科学基金(81771233);首都卫生发展专项项目(2018-2-2041);北京市科技计划课题京津冀协同创新推动项目(Z181100009618035)。

摘　　要：目的探讨房颤合并急性颅内大动脉闭塞患者的临床特点及机械取栓疗效。方法纳入East(endovascular therapy for acute ischemic stroke trial)研究中房颤合并急性颅内大动脉闭塞患者58例,East研究是由北京天坛医院于2016年联合全国17家卒中中心同期开展的前瞻性、非随机对照研究。根据TOAST(trial of Org 10172 in acute stroke treatment)分型,将患者分为心源性栓塞组和动脉粥样硬化组(ICAS)。分析房颤合并急性颅内大动脉闭塞患者的临床特点、治疗方式及临床预后。结果本研究共纳入房颤合并急性颅内大动脉闭塞患者58例,其中栓塞组46例(79%),ICAS组12例(21%);ICAS组院前转运时间要长于心源性栓塞组(P<0.05)。房颤合并急性颅内大动脉闭塞患者取栓开通率为98.3%(57/58),90 d功能独立(改良RANKIN量表0~2分)患者比例为51.7%(30/58)。心源性栓塞组和ICAS组患者在90 d功能独立、死亡比例、颅内出血及症状性颅内出血方面差异无统计学意义。结论机械取栓治疗房颤伴发急性颅内大动脉闭塞是一项有效的治疗方法。Objective To investigate the safety and efficacy of mechanical thrombectomy in patients with atrial fibrillation complicated with acute intracranial arterial occlusion.Methods Fifty-eight patients with atrial fibrillation complicated with acute intracranial arterial occlusion in the intervention group of East(Endovascular Therapy for Acute ischemic Stroke Trial)were analyzed.According to the TOAST(Trial of Org 10172 in Acute Stroke Treatment)classification,patients were divided into ICAS(Intracranial Atherosclerotic Stenosis)group and cardiogenic embolism group.Clinical characteristics,treatment methods and clinical prognosis were compared between ICAS group and cardiogenic embolism group.Results A total of 58 patients with atrial fibrillation complicated with acute intracranial arterial occlusion were included in this study,including 46 patients in the cardiogenic embolism group(79%)and 12 patients in the ICAS group(21%).The pre-hospital transport time in ICAS group was longer than that in cardiogenic embolism group(P<0.05).Patency rate in patients with atrial fibrillation complicated with acute intracranial arterial occlusion was 98.3%(57/58),The rate of patients with the 90-day function independent(mRS 0-2)was 51.7%(30/58).There were no statistically significant differences in functional independence,mortality rate,ICH and sICH at 90 days between the cardiogenic embolism group and the ICAS group.Conclusions Mechanical thrombectomy is an effective method to treat patients with atrial fibrillation complicated with acute intracranial arterial occlusion.

关 键 词：房颤 颅内栓塞 血栓切除术 预后 

分 类 号：R54[医药卫生—心血管疾病]