发病4.5至9.0小时前循环大血管闭塞急性缺血性卒中患者行桥接治疗与直接取栓的疗效及安全性对比分析  

Efficacy and safety analysis of bridging therapy versus direct endovascular thrombectomy in patients of acute ischemic stroke with large vessel occlusion in the anterior circulation within 4.5-9.0 hours

作　　者：赛俊杰 张环 韩红星[1] 王浩[1] 崔言森 车峰远[1] Sai Junjie;Zhang Huan;Han Hongxing;Wang Hao;Cui Yansen;Che Fengyuan(Department of Neurology,the 11th Clinical College of Qingdao University,Linyi People′s Hospital,Shandong 276000,China)

机构地区：[1]青岛大学第十一临床学院临沂市人民医院神经内科,276000

出　　处：《中国脑血管病杂志》2023年第10期649-658,共10页Chinese Journal of Cerebrovascular Diseases

基　　金：山东省医药卫生科技发展计划项目(2019WS122)。

摘　　要：目的比较发病4.5~9.0 h的前循环大血管闭塞急性缺血性卒中患者行桥接治疗和直接取栓的疗效及安全性。方法回顾性连续纳入2020年1月1日至2022年12月31日于临沂市人民医院卒中中心收治的发病4.5~9.0 h的前循环大血管闭塞的急性缺血性卒中患者96例。收集患者的基线资料和临床资料。基线资料包括性别、年龄、既往病史(高血压病、糖尿病、心房颤动、卒中)、发病前改良Rankin量表(mRS)评分、入院血压、就诊时美国国立卫生研究院卒中量表(NIHSS)评分、卒中病因分型、病变血管部位、Alberta卒中项目早期CT评分(ASPECTS)、核心梗死及低灌注体积、术前改良脑梗死溶栓(mTICI)分级、时间指标(包括发病至就诊时间、门诊至静脉溶栓给药时间、给药至动脉穿刺时间、门诊至动脉穿刺时间、发病至动脉穿刺时间、动脉穿刺至血管再通时间、发病至血管再通时间)、取栓方法、取栓次数等,临床资料包括术后90 d mRS评分(0~2分为预后良好,3~6分为预后不良,其中6分为死亡)、术中末次造影血管mTICI分级(mTICI分级≥2b级定义为良好再通)、术后72 h症状性颅内出血、术后24 h内穿刺点并发症。根据机械取栓前是否行静脉溶栓将所有患者分为桥接治疗组和直接取栓组。比较两组患者基线资料、主要观察指标(术后90 d良好预后率)、次要观察指标(术中末次造影血管良好再通比例、术后90 d mRS评分分布)、安全性指标(术后90 d全因死亡率、术后72 h症状性颅内出血发生率及术后24 h内穿刺点并发症发生率)。本研究对年龄(<70岁、≥70岁)、性别(男性、女性)、心房颤动(是、否)、入院时收缩压(<160 mmHg、≥160 mmHg)、就诊时NIHSS评分(>5分且<18分、≥18分)、ASPECTS(<7分、≥7分)、血管闭塞部位(大脑中动脉M1、M2段及颈内动脉颅内段)、卒中病因分型(颅内动脉粥样硬化性狭窄、心源性栓塞、颅外段�Objective To investigate the efficacy and safety between bridging therapy and direct endovascular thrombectomy in patients with acute large vessel occlusion in the anterior circulation within 4.5-9.0 hours.Methods A total of 96 stroke patients with acute large vessel occlusion in the anterior circulation within 4.5-9.0 hours and admitted at the Stroke Center of Linyi People′s Hospital from January 2020 to December 2022 were retrospectively included.Baseline data and clinical data were collected.Baseline data included gender,age,past medical history(hypertension,diabetes,atrial fibrillation,stroke),pre-disease modified Rankin scale(mRS),admission blood pressure,National Institutes of Health stroke scale(NIHSS)at visit,stroke etiology type,location of occlusion,Alberta stroke program early CT score(ASPECTS),core infarction volume,hypoperfusion volume,preoperative modified thrombolysis in cerebral infarction(mTICI)classification and time indexes(including time from onset to visit,time from outpatient to intravenous thrombolysis,time from administration to arterial puncture,time from outpatient to arterial puncture,time from onset to arterial puncture,time from arterial puncture to recanalization,and time from onset to recanalization),thrombectomy technique,and number of passes.Clinical data included mRS scores at 90 days after surgery(mRS scores 0-2 classified as good prognosis,3-6 as poor prognosis,and 6 as death),mTICI grade at the last angiography(mTICI grade≥2b defined as successful recanalization),symptomatic intracranial hemorrhage within 72 h after surgery and complication of puncture site within 24 h after surgery.According to whether prior intravenous thrombolysis or not,they were divided into bridging therapy group and direct endovascular thrombectomy group.Baseline data,main outcome indicators(good prognosis rate at 90 days after surgery),secondary outcome indicators(successful recanalization rate at last intraoperative angiography,mRS scores distribution at 90 days after surgery),safety indicators(al

关 键 词：缺血性卒中 前循环 机械取栓 桥接治疗 大血管闭塞 

分 类 号：R651.12[医药卫生—外科学]