前后循环大血管闭塞致急性缺血性卒中患者机械取栓治疗效果比较  

Comparison of mechanical thrombectomy in patients with acute ischemic stroke caused by anterior and posterior circulation occlusion

作　　者：陈忠军[1] 闯闯 胡腾 李迪[1] Chen Zhongjun;Chuang Chuang;Hu Teng;Li Di(Department of Neurological Intervention and Neurological Intensive Care,Dalian Municipal Central Hospital,Dalian,Liaoning 116000,China)

机构地区：[1]大连市中心医院神经介入及神经重症科,116000

出　　处：《中国脑血管病杂志》2023年第2期84-89,105,共7页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的对比分析前、后循环大血管闭塞所致急性缺血性卒中机械取栓治疗的安全性和有效性。方法回顾性连续纳入大连市中心医院神经介入及神经重症科2019年1月至2021年12月经DSA证实为颅内外大血管闭塞的急性缺血性卒中住院患者405例,均行机械取栓治疗。依据责任血管闭塞部位的不同,将405例患者分为前循环组(335例)和后循环组(70例)。对两组患者的基线资料[年龄、性别、体质量指数、基线美国国立卫生研究院卒中量表(NIHSS)评分、静脉溶栓情况、既往病史(高血压病、糖尿病、心房颤动)、吸烟史、饮酒史、术前收缩压]、手术相关资料[发病至再通时间、取栓次数、一次再通、支架置入、卒中病因分型(大动脉粥样硬化、栓塞、病因不明)]、术后(血管成功再通、血管完全再通)和结局终点(主要结局和次要结局)进行对比分析。术后血管成功再通为改良脑梗死溶栓(mTICI)分级2b~3级,血管完全再通为mTICI分级3级。主要结局终点为机械取栓治疗后3个月的功能独立[改良Rankin量表(mRS)评分0~2分];次要结局终点包括其他临床结局(取栓治疗后3个月内死亡)及安全性结局(住院期间发生症状性颅内出血)。结果术前接受静脉溶栓治疗患者183例(45.2%)。(1)前循环组患者年龄高于后循环组[(69±11)岁比(66±10)岁,t=2.107],体质量指数低于后循环组[(23.1±3.0)kg/m^(2)比(25.2±2.8)kg/m^(2),t=-5.386],基线NIHSS评分、术前收缩压均低于后循环组[(18±6)分比(24±8)分,t=-7.148;(141±27)mmHg比(153±23)mmHg,t=-3.464],组间差异均有统计学意义(均P<0.05)。两组患者性别、静脉溶栓、高血压病、糖尿病、心房颤动、烟酒史比例的差异均无统计学意义(均P>0.05)。(2)前循环组与后循环组患者发病至再通时间的差异无统计学意义(P>0.05)。后循环组取栓次数少于前循环组[1.20(1.00,3.00)次比2.10(1.00,6.00)次,Z=9.343],一次再通率、�Objective To compare the efficacy and safety of mechanical thrombectomy in the treatment of acute ischemic stroke between anterior and posterior circulation large vessel occlusion.Methods A total of 405 inpatients with acute ischemic stroke confirmed by DSA as intracranial and extracranial large vessel occlusion from January 2019 to December 2021 were retrospectively included in the Department of Neurological Intervention and Neurological Intensive Care of Dalian Municipal Central Hospital.All of them received mechanical thrombolysis.According to the location of responsible vessel occlusion,405 patients were divided into anterior circulation group(335 cases)and posterior circulation group(70 cases).Baseline data(age,gender,body mass index[BMI],baseline National Institutes of Health Stroke Scale[NIHSS]score,intravenous thrombolysis status,past medical history[hypertension,diabetes,atrial fibrillation],smoking history,alcohol consumption history,preoperative systolic blood pressure),and surgical data(time from onset to recanalization,number of thrombectomy,first-pass recanalization,stent placement,stroke etiology[atherosclerosis,embolism,and unknown etiology]),postoperatively(successful recanalization,complete recanalization),and endpoints(primary and secondary outcomes)were compared.Successful vascular recanalization after surgery was classified as modified cerebral infarction thrombolysis(mTICI)grade 2b-3,and complete vascular recanalization was classified as mTICI grade 3.The primary outcome was functional independence at 3 months after mechanical thrombectomy(modified Rankin scale[mRS]score 0-2).Secondary outcomes included other clinical outcomes(death within 3 months after thrombectomy)and safety outcomes(symptomatic intracranial hemorrhage during hospitalization).Results There were 183 patients(45.2%)who received intravenous thrombolysis before surgery.(1)The age of the anterior circulation group was higher than that of the posterior circulation group([69±11]years old vs.[66±10]years old,t=2.107)and the BMI

关 键 词：缺血性卒中 脑梗死 椎动脉供血不足 前循环 后循环 血管内治疗 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]