急性前循环大血管闭塞性脑卒中合并房颤患者行直接机械取栓治疗取栓方式的临床效果  

Clinical effects of thrombectomy method in patients with acute anterior circulation great vessel occlusive stroke combined with atrial fibrillation undergoing direct mechanical thrombectomy

作　　者：田伟[1] 杨华[1] 高岩[1] 杨章超[1] 张泰民[1] 马文群[1] TIAN Wei;YANG Hua;GAO Yan;YANG Zhangchao;ZHANG Taimin;MA Wenqun(No.1 Department of Neurosurgery,Handan Central Hospital,Handan,Hebei 056006,China)

机构地区：[1]河北省邯郸市中心医院神经外一科,河北邯郸056006

出　　处：《国际检验医学杂志》2022年第20期2496-2500,共5页International Journal of Laboratory Medicine

基　　金：河北省邯郸市科学技术研究与发展计划项目(19422083009-2)。

摘　　要：目的探讨急性前循环大血管闭塞性脑卒中(AIS-LVO)合并房颤患者行直接机械取栓治疗不同取栓方式的临床效果。方法选取2019年8月至2021年5月于该院行直接机械取栓治疗的82例AIS-LVO合并房颤患者作为研究对象,根据取栓方式不同分为单支架组(41例)和导管配合组(41例)。单支架组采用单支架取栓治疗,导管配合组采用中间导管配合支架取栓治疗,两组术后均给予替罗非班防止血管再闭塞。比较两组的疗效、治疗情况、出血转化情况及治疗前后血清S100β蛋白(S100β)、基质细胞衍生因子-1(SDF-1)、同型半胱氨酸(Hcy)水平,以及美国国立卫生研究院卒中量表(NIHSS)、Alberta卒中项目早期CT(ASPECT)、脑卒中专用生活质量量表(SS-QOL)、Barthel指数(BI)评分。结果导管配合组治疗总有效率(92.68%)、靶血管开通率(90.24%)、症状性颅内出血发生率(4.88%)与单支架组(80.49%、78.05%、14.63%)比较,差异均无统计学意义(P>0.05);导管配合组平均取栓次数、远端栓塞发生率、出血转化发生率均低于单支架组,开通时间短于单支架组,差异均有统计学意义(P<0.05);导管配合组治疗后1、3 d血清S100β、Hcy水平均低于单支架组,血清SDF-1水平均高于单支架组,差异均有统计学意义(P<0.05);导管配合组治疗后1、2周NIHSS评分低于单支架组,ASPECT评分高于单支架组,差异均有统计学意义(P<0.05);导管配合组治疗后1、3个月SS-QOL、BI评分均高于单支架组,差异均有统计学意义(P<0.05)。结论单支架取栓、中间导管配合支架取栓均为治疗AIS-LVO合并房颤患者的有效方法,可获得较高的血管开通率,中间导管配合支架取栓能更有效减少术后出血转化发生,进一步改善患者预后。Objective To explore the clinical effects of different thrombectomy methods in patients with acute anterior circulation great vessel occlusive stroke(AIS-LVO)combined with atrial fibrillation undergoing direct mechanical thrombectomy.Methods A total of 82 patients with AIS-LVO combined with atrial fibrillation who underwent direct mechanical thrombectomy in the hospital from August 2019 to May 2021 were selected as research objects,and were divided into single stent group(41 cases)and catheter coordination group(41 cases)according to different thrombectomy methods.The single stent group was treated with a single stent thrombus removal,and the catheter group was treated with a intermediate catheter combined with stent thrombus removal.Both groups were given tirofiban after surgery to prevent reocclusion of blood vessels.The efficacy,treatment,hemorrhage transformation,serum S100βprotein(S100β),stromal cell-derived factor-1(SDF-1),homocysteine(Hcy)levels,National Institute of Health Stroke Scale(NIHSS),Alberta Stroke Project Early CT(ASPECT),Stroke Special Quality of Life Scale(SS-QOL),Barthel Index(BI)scores before and after treatment were compared between the two groups.Results The total effective rate of treatment(92.68%),target vessel opening rate(90.24%),symptomatic intracranial hemorrhage(4.88%)in the catheter coordination group had no statistically significant differences when compared with the single stent group(80.49%,78.05%,14.63%)(P>0.05).The average number of thrombus removal,distal embolization rate,and hemorrhagic transformation rate in the catheter coordination group were lower than those in the single stent group,and the opening time was shorter than that in the single stent group,and the differences were statistically significant(P<0.05).Serum S100βand Hcy levels in the catheter coordination group were lower than those in the single stent group at 1 and 3 days after treatment,and the serum SDF-1 level was higher than that in the single stent group,and the differences were statistically significa

关 键 词：急性前循环大血管闭塞性脑卒中 机械取栓 Solitaire支架 中间导管 出血转化 

分 类 号：R743.3[医药卫生—神经病学与精神病学]