发病4.5小时内急性基底动脉闭塞性卒中行桥接治疗与直接取栓的有效性和安全性分析  

Efficacy and safety of bridging therapy versus direct thrombectomy in acute basilar artery occlusive stroke within 4.5 hours of onset

作　　者：刘荣毅 温昌明 孙军 汪宁 张在行 郭彦俊 郭元展 郑皓存 Liu Rongyi;Wen Changming;Sun Jun;Wang Ning;Zhang Zaixing;Guo Yanjun;Guo Yuanzhan;Zheng Haocun(Department of Neurointervention,Nanyang Central Hospital,Xinxiang Medical University,Nanyang,Henan 473000,China)

机构地区：[1]新乡医学院南阳市中心医院神经介入科,河南省南阳市473000

出　　处：《中国脑血管病杂志》2025年第3期145-156,共12页Chinese Journal of Cerebrovascular Diseases

基　　金：河南省医学科技攻关计划项目(LHGJ20240783)。

摘　　要：目的比较发病4.5 h内基底动脉闭塞引起的急性缺血性卒中患者行桥接治疗与直接取栓治疗的有效性和安全性。方法回顾性连续纳入2018年1月至2024年8月5家医疗中心收治的发病4.5 h内的急性基底动脉闭塞性卒中患者,根据治疗方式分为桥接治疗(急诊取栓前给予阿替普酶静脉溶栓)组和直接取栓组。收集患者的基线及临床资料,包括年龄、性别、入院时收缩压和舒张压、既往史(高血压病、糖尿病、冠心病、心房颤动、高脂血症、卒中史)、吸烟史、发病前改良Rankin量表(mRS)评分、入院时美国国立卫生研究院卒中量表评分、入院时后循环Alberta卒中项目早期CT评分、基底动脉CT血管成像评分、术前抗血小板聚集药物应用史、术前抗凝药物应用史、动脉穿刺入路选择(经股动脉或经桡动脉)、血管闭塞部位(基底动脉近段、基底动脉中段、基底动脉远段)、急性卒中Org 10172治疗试验(TOAST)分型、美国介入和治疗神经放射学学会/介入放射学学会侧支循环分级、发病至入院时间、入院至穿刺时间、穿刺至血管再通时间、发病至血管再通时间、取栓技术(支架取栓、抽吸取栓及联合取栓)、补救措施(球囊扩张、支架置入、球囊扩张联合支架置入)、术后即刻扩展脑梗死溶栓(eTICI)分级以及手术相关并发症(动脉夹层、远端闭塞及动脉穿孔)。比较两组患者有效性指标[术后90 d良好预后(mRS评分0~3分)率、术后90 d病死(mRS评分6分)率、术后即刻血管良好再通(eTICI分级≥2b50级)率]及安全性指标[术后7 d内症状性颅内出血(sICH)发生率]。通过倾向性评分匹配(PSM)将两组患者以1∶1的比例进行匹配,比较两组1∶1 PSM前后有效性及安全性指标的差异。将两组1∶1 PSM前基线及临床资料比较结果中P<0.05的变量纳入多因素Logistic回归分析进行校正,比较校正前后两组患者安全性及有效性指标的差Objective To compare the efficacy and safety of bridging therapy and direct thrombectomy in patients with acute ischemic stroke caused by basilar artery occlusion within 4.5 h.Methods Retrospective consecutive patients with acute basilar artery occlusion stroke within 4.5 h of onset admitted to five centers from January 2018 to August 2024 were included and divided into a bridging therapy(intravenous thrombolysis with alteplase given prior to emergency endovascular treatment)group and a direct thrombectomy group according to the treatment modality.Baseline and clinical data were collected from patients,including age,sex,systolic and diastolic blood pressure on admission,past history(including history of hypertension,diabetes mellitus,coronary artery disease,atrial fibrillation,hyperlipidemia,and history of stroke),history of smoking,pre-morbid modified Rankin scale(mRS)scores,National Institutes of Health stroke scale(NIHSS)score on admission,posterior circulation Alberta stroke program early CT score on admission,basilar artery CT angiography score,history of pre-procedural antiplatelet aggregation medications,history of pre-procedural anticoagulant medications,choice of arterial puncture access(via femoral or radial artery),site of vascular occlusion(proximal basilar artery,mid-basilar artery,distal basilar artery),trial of Org 10172 in acute stroke treatment(TOAST)classification,American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology collateral circulation classification,time from onset to admission,time from admission to puncture,time from puncture to revascularization,time from onset to revascularisation,type of embolisation procedure(stenting,aspiration,and combined),immediate post-procedure extended thrombolysis in cerebral infarction(eTICI)classification,and intra-procedural related complications(arterial entrapment,distal occlusion and arterial perforation).The main efficacy indicators(good prognosis[mRS score 0-390 d postoperatively],death[mRS score 690 d po

关 键 词：基底动脉 溶栓治疗 桥接治疗 血管内治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]