急性椎基底动脉闭塞串联病变机械取栓治疗预后分析  

Mechanical thrombectomy for acute tandem vertebrobasilar occlusions: analysis of prognosis

作　　者：韩熙成 韩凯昊[2] 付晓杰 徐浩文[2] 闫保君[2] 权涛[2] 赵岩江 管生[2] HAN Xicheng;HAN Kaihao;FU Xiaojie;XU Haowen;YAN Baojun;QUAN Tao;ZHAO Yanjiang;GUAN Sheng(Department 0f Neurology,Suiping Renan Hosipital,Zhumadian,Henan Prorince 463100,China)

机构地区：[1]遂平仁安医院神经内科,河南驻马店463100 [2]郑州大学第一附属医院神经介入科

出　　处：《介入放射学杂志》2021年第3期225-229,共5页Journal of Interventional Radiology

摘　　要：目的分析急性椎基底动脉闭塞患者机械取栓治疗的预后,评价串联病变对预后的影响。方法回顾性分析2015年9月至2019年4月郑州大学第一附属医院等3家医院采用机械取栓治疗的179例椎基底动脉闭塞患者临床和影像学资料。其中串联病变患者20例,单处病变159例。比较分析不同病变组间基线特征、再通率、治疗策略、并发症及90 d预后,评估影响串联病变患者预后的因素。结果术后总成功再通率为96.6%(173/179),90 d预后良好率为43.6%(78/179)。串联病变组手术时间显著长于单处病变组[(87.0±13.0)min对(67.0±15.0)min,P<0.0001]。串联病变组、单处病变组预后良好率分别为20.0%、46.5%(P=0.030)。支架植入和替罗非班应用不增加症状性颅内出血和90 d死亡风险。结论机械取栓能有效改善急性椎基底动脉闭塞患者脑卒中预后,但串联病变手术难度较高,手术时间较长,患者预后较差。Objective To analyze the prognosis of patients with acute vertebrobasilar artery occlusions after receiving mechanical thrombectomy,and to evaluate the influence of tandem lesions on prognosis.Methods The clinical data and imaging materials of 179 patients with acute vertebrobasilar artery occlusions,who were separately admitted to three hospitals including the First Affiliated Hospital of Zhengzhou University of China during the period from September 2015 to April 2019 to receive mechanical thrombectomy treatment,were retrospectively analyzed.Of the 179 patients,tandem occlusions were diagnosed in 20(tandem group)and single lesion in 159(single lesion group).The baseline features,recanalization rate,treatment strategy,complications and 90-day prognosis were compared between the two groups,and the factors affecting prognosis of patients with tandem occlusions were evaluated.Results The total successful recanalization rate was 96.6%(173/179),and 43.6%of patients(78/179)obtained a favorable prognosis.The time spent on the operative procedure in the tandem group was(87.0±13.0)min,which was remarkably longer than(67.0±15.0)min in the single lesion group(P<0.0001).Good prognosis rate in the tandem group and the single lesion group was 20.0%and 46.5%respectively(P=0.030).Additional stent implantation and use of tirofiban did not increase the risks of symptomatic intracranial hemorrhage and 90-day mortality.Conclusion Mechanical thrombectomy can effectively improve the stroke prognosis in patients with acute vertebrobasilar artery occlusions.However,for acute tandem vertebrobasilar occlusions the operation is difficult,the time spent on the operative procedure is longer,and the prognosis of patients is poor.(J Intervent Radiol,2021,30:225-229)。

关 键 词：串联病变 机械取栓 预后 椎基底动脉 闭塞 

分 类 号：R543.4[医药卫生—心血管疾病]