大血管闭塞残端形态对急性缺血性脑卒中早期血管内机械开通术式及疗效的影响  

Influence of great vessels occlusion stump morphology to acute ischemic stroke early endovascular mechanical opening operation and curative effect

作　　者：录海斌 郭耀强 焦勇钢[2] 王晓洁[1] LU Haibin;GUO Yaoqiang;JIAO Yonggang;WANG Xiaojie(People’s Hospital Affiliated to Henan University of Chinese Medicine,Zhengzhou 450003,China;Second People’s Hospital of Guangdong Province,Guangzhou 510000,China)

机构地区：[1]河南中医药大学附属人民医院,河南郑州450003 [2]广东省第二人民医院,广东广州510000

出　　处：《中国实用神经疾病杂志》2023年第2期147-152,共6页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探讨急性大血管闭塞残端对缺血性脑卒中早期血管内机械开通术式选择及疗效的影响。方法纳入河南中医药大学附属人民医院2019-03—2022-01大血管闭塞所致急性缺血性脑卒中机械取栓患者为研究对象。按照首次给予机械开通术式分为吸栓组(31例)和支架取栓组(25例);每组依据急性闭塞大血管残端形态分为无残端亚组及有残端亚组;共纳入18项指标。结果56例患者中共41例开通成功,总开通率为73.21%。吸栓组23例成功开通,支架取栓组18例成功开通。吸栓组平均DRT时间明显短于支架取栓组(P<0.05);吸栓组并发症发生率明显低于支架取栓组(P<0.05)。吸栓组内无残端亚组开通率明显高于有残端亚组(P<0.05);支架取栓组内无残端亚组开通率高于有残端亚组(P<0.05)。结论对于无残端的急性大血管闭塞,抽吸取栓与支架取栓血管开通率相当,但直接抽吸技术DRT时间明显缩短,手术相关并发症少;对于有残端的血管闭塞,无论是吸栓或支架取栓效果均欠佳;术前对急性闭塞大血管残端形态评估,对术中机械取栓方式的选择有一定指导意义并影响临床疗效。Objective To investigate the effect of acute large vessel occlusion of the stump on the selec⁃tion and efficacy of endovascular mechanical opening in the early stage of ischemic stroke.Methods Patients with acute ischemic stroke caused by large vessel occlusion in the Affiliated People’s Hospital of Henan Universi⁃ty of Traditional Chinese Medicine from March 2019 to January 2022 were enrolled as the research objects.Ac⁃cording to the first mechanical operation,they were divided into aspiration thrombectomy and stent retriever throm⁃bectomy group.Each group was divided into non-stump subgroup and stump subgroup according to the morpholo⁃gy of acute occluded large vessels.A total of 18 indicators were included.Results Among the 56 patients included,41 patients were successfully opened,with a total opening rate of 73.21%.Of the 31 patients in the aspi⁃ration thrombectomy group,23 were successfully opened.The stent retriever thrombectomy group consisted of 25 patients:18 patients were successfully opened.The average DRT time in aspiration thrombectomy group was significantly shorter than that in stent retriever thrombectomy group(P<0.05).The complication rate of aspiration thrombectomy group was significantly lower than that of stent retriever thrombectomy group(P<0.05).In the aspi⁃ration thrombectomy group,the opening rate of the non-stump subgroup was significantly higher than that of the stump subgroup(P<0.05).In the stent retriever thrombectomy group,the opening rate of the subgroup without stump was higher than that of the subgroup with stump(P<0.05).Conclusion For acute large vessel occlusion without stump,the vascular opening rate of aspiration thrombectomy is similar to that of stent retriever thrombecto⁃my,but the DRT time of direct s aspiration thrombectomy is significantly shorter and surgery-related complica⁃tions are less.For vascular occlusion with stump,both aspiration thrombectomy and stent retriever thrombectomy have poor effect.Preoperative evaluation of the morphology of acute

关 键 词：大血管闭塞残端形态 急性缺血性脑卒中 血管内机械开通 静脉溶栓 血管内介入 

分 类 号：R743.3[医药卫生—神经病学与精神病学]