血管内机械取栓治疗大血管闭塞性轻型脑卒中的安全性和有效性分析  

Safety and efficacy of mechanical thrombectomy in minor stroke with large vessel occlusion

作　　者：王桂芳[1] 杨晓倩[1] 肖以磊[2] 马维斌[1] 刘书平[3] 卢祖能[3] Wang Guifang;Yang Xiaoqian;Xiao Yilei;Ma Weibin;Liu Shuping;Lu Zuneng(Department of Neurology,Liaocheng Peopled Hospital,Liaocheng 252000,China;department of Neurosurgery,Liaocheng People's Hospital,Liaocheng 2520009 China;Department of Neurology^Renmin Hospital,Wuhan University9 Wuhan 430060,China)

机构地区：[1]聊城市人民医院神经内科,252000 [2]聊城市人民医院神经外科,252000 [3]武汉大学人民医院神经内科,武汉430060

出　　处：《中华神经医学杂志》2020年第7期711-714,共4页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金(81701159);中国博士后科学基金(2018M632123);山东省自然科学基金(ZR2015HQ023)。

摘　　要：目的探讨大血管闭塞性轻型脑卒中患者血管内机械取栓治疗的有效性和安全性。方法回顾性收集自2017年1月至2019年7月聊城市人民医院神经内科收治的行机械取栓治疗的轻型脑卒中患者23例,存在静脉溶栓禁忌证的患者给予直接取栓治疗,否则给予桥接治疗(静脉溶栓联合机械取栓)。采用美国国立卫生研究院卒中量表(NIHSS)评分评估神经功能缺损程度,包括入院时、治疗后12h和治疗后7d。采用改良脑梗死溶栓(mTICI)分级评估血管再通情况,采用改良Rankin量表(mRS)评分评估90d时患者预后。安全性指标包括症状性颅内出血、并发症发生率及90d死亡率。结果22例患者成功再通,术后mTICI分级3级19例、2b级3例。患者入院时NIHSS评分为3(2,5),治疗后12h NIHSS评分为2(2,3),治疗后7d NIHSS评分为2(1,2);整体比较差异有统计学意义(χ^2=14.028,P=0.001),其中治疗后12h、治疗后7d NIHSS评分均明显低于入院时NIHSS评分,差异有统计学意义(P<O.O5)。90d时预后良好患者16例(69.6%),预后不良患者7例(30.4%)。安全性方面,症状性颅内出血共出现2例,10例发生全身并发症,死亡1例。结论大血管闭塞性轻型脑卒中患者行血管内机械取栓治疗安全有效。Objective To explore the efficacy and safety of mechanical thrombectomy(MT)in patients with minor stroke with large vessel occlusion(LVO).Methods Twenty-three patients with minor stroke with LVO,admitted to our hospital from January 2017 to July 2019,were consecutively collected in our study;patients with contraindications of intravenous thrombolysis should be treated with direct thrombectomy,and the left were given bridging therapy(intravenous thrombolysis combined with MT).NIHSS scores were used to assess the degrees of neurological impairment at admission,and 12 h and 7 d after treatment.Vascular recanalization was assessed by modified cerebral infarction thrombolysis(mTICI)grading,with grading 2B-3 defined as successful recanalization.The prognoses 90 d after treatment were assessed by modified Rankin scale(mRS),and mRS scores≤2 was classified as having good prognosis.Safety indicators included symptomatic intracranial hemorrhage,incidence of complications,and mortality 90 d after treatment.Results Twenty-two patients had successfully recanalization;19 patients had mTICI grading 3 and 3 patients had grading 2B.The NIHSS scores were 3(2,5)at admission,2(2,3)12 h after treatment,and 2(1,2)7 d after treatment,with significant difference(χ^2=14.028,P=0.001);NIHSS scores 12 h and 7 d after treatment were signijficantly lower than those at admission(P<0.05).Sixteen patients(69.6%)enjoyed good prognosis and 7 patients(30.4%)had poor prognosis.In terms of safety,two patients had symptomatic intracranial hemorrhage,10 had systemic complications,and one died during 90-d of follow-up.Conclusion MT is effective and safe in minor stroke patients with LVO.

关 键 词：轻型脑卒中 大血管闭塞 机械取栓 

分 类 号：R743.3[医药卫生—神经病学与精神病学]