基于颅脑CT灌注成像筛选的急性基底动脉闭塞性脑梗死的血管内再通治疗临床研究  

Clinical study of stent-retriever mechanical thrombectomy in treatment of acute basilar artery occlusion based on CT perfusion imaging

作　　者：张清清 傅聪 傅新民 马庆防[2] 张洋[2] 陆俊杰 李峤[2] 平蕾 施洪超[3] ZHANG Qing-qing;FU Cong;FU Xin-min;MA Qing-fang;ZHANG Yang;LU Jun-jie;LI Qiao;PING Lei;SHI Hong-chao(Graduate School of Bengbu Medical College,Bengbu 233000,Anhui,China;Xuzhou Central Hospital,Xuzhou 221009,Jiangsu,China;Nanjing First Hospital,Nanjing 210006,Jiangsu,China)

机构地区：[1]蚌埠医学院研究生院,安徽蚌埠233000 [2]徐州市中心医院,江苏徐州221009 [3]南京市第一医院,江苏南京210006

出　　处：《生物医学工程与临床》2021年第2期155-159,共5页Biomedical Engineering and Clinical Medicine

基　　金：徐州市社会发展-公共卫生项目(KC16SW175)。

摘　　要：目的基于颅脑CT灌注成像(CTP)筛选的急性基底动脉闭塞性脑梗死血管内再通治疗的临床安全性及治疗效果。方法选择发病12 h内、责任血管椎基底动脉完全闭塞且住院的急性后循环脑梗死患者60例,其中男性40例,女性20例;年龄39~94岁,平均年龄63.32岁。行一站式颅脑CT平扫和CTP检查。采用简单随机抽样法,分为2组。治疗组30例,采用血管内治疗联合标准脑梗死药物治疗;对照组30例,采用标准脑梗死药物治疗。采用脑梗死溶栓(TICI)分级评估两组血管再通、颅脑CT平扫评估症状性出血,用颅脑CT血管造影或磁共振血管造影评估再闭塞情况;采用90 d改良Rankin量表(m RS)对比两组临床预后和90 d死亡率。结果60例基底动脉完全闭塞处于梗死前期缺血的程度为Ⅰ~Ⅱ1期。其中治疗组Ⅰ1期11例,Ⅰ2期7例,Ⅱ1期12例;对照组Ⅰ1期10例,Ⅰ2期6例,Ⅱ1期14例。治疗组术后血流TICI分级2b或3级的比例高于对照组[93.33%(28/30)vs 6.67%(2/30);P<0.01]。治疗组预后良好率高于对照组(60.00%vs 13.33%;P<0.01)。治疗组90 d死亡率低于对照组(26.67%vs 66.67%;P<0.01)。治疗组症状性脑出血发生率虽然高于对照组(10.00%vs 6.67%),但差异无统计学意义(P=0.46)。治疗组死亡率低于对照组(26.67%vs66.67%;P<0.01)。结论急性后循环脑梗死患者在发病12 h内,经一站式颅脑CT平扫和CTP检查筛选处于梗死前Ⅰ~Ⅱ1期,采用血管内治疗技术和标准脑梗死药物治疗,临床症状改善显著,预后良好。Objective To evaluate the clinical safety and efficacy of endovascular therapy in patients with acute basilar artery occlusion stroke based on CT perfusion imaging(CTP).Methods A total of 60 patients with cerebral infarction within 12 hours of onset were enrolled,which included 40 males and 20 females,aged 39-94 years old with mean age of 63.32 years old.The one-stop cerebral CT scan and CTP examination were performed,all of them were randomly divided into treatment group(n=30,with endovascular therapy combined standard cerebral infarction drugs)and control group(n=30,with standard medical cerebral infarction treatment).The thrombolysis in cerebral infarction(TICI)grading was used to assess recanalization,symptomatic hemorrhage and reocclusion of 2 groups.CT angiography or magnetic resonance angiography were used to evaluate reocclusion.The 90-day modified Rankin scale(m RS)was used to compare clinical prognosis and 90-day mortality between 2 groups.Results Sixty complete occlusion of basilar artery were in pre-infarction stage of ischemia were stageⅠ-Ⅱ1.In treatment group,there were 11 cases of stageⅠ1,7 of stageⅠ2 and 12 of stageⅡ1;In control group,10 cases were stageⅠ1,6 of stageⅠ2 and 14 stageⅡ1.The proportion of postoperative blood flow TICI grading 2 b or 3 in treatment group was higher than that in control group[93.33%(28/30)vs 6.67%(2/30);P<0.01].The good prognosis rate in treatment group was significantly higher than that in control group(60.00%vs 13.33%;P<0.01).The 90-day mortality rate in treatment group was significantly lower than that in control group(26.67%vs 66.67%;P<0.01).The incidence of symptomatic cerebral hemorrhage in treatment group was higher than that in control group(10.00%vs 6.67%),but without statistically significant difference(P=0.46).The mortality rate in treatment group was lower than that in control group(26.67%vs 66.67%;P<0.01).Conclusion It is demonstrated that acute posterior circulation cerebral infarction patients with stageⅠ-Ⅱ1 before infarction performed

关 键 词：急性脑梗死 基底动脉闭塞 脑血栓取出装置 血栓抽吸系统 颅脑CT灌注成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.3[医药卫生—临床医学]