Trevo支架与Solitaire支架对急性缺血性脑卒中的血管再通疗效比较

目的 比较Trevo支架和Soliatire支架对急性缺血性脑卒中(acute ischemic stroke,AIS)机械取栓术中血管再通及术后并发症的影响。方法 回顾性纳入200例在本院接受支架取栓术的AIS患者,根据选用的支架类型将患者分为Solitaire支架组(102例)和Trevo支架组(98例); 以NIHSS评分和改良Rankin量表(mRS)评估患者的神经功能预后; 以脑梗死溶栓分级(thrombolysis in cerebral infarction,TICI)评估血管再灌注情况,比较患者术后并发症的发生率,并通过logistics回归分析确定影响并发症发生及血管再通的独立危险因素。结果 Trevo组的30d NIHSS评分显著低于Solitaire组[3(0～13)vs 6(0～17),P<0.05],且90d的mRS评分也显著低于Solitaire组[2(0～5)vs 3(0～6),P<0.05],但2组术后脑卒中进展、远端血栓或栓子形成、术后出血、死亡等并发症发生率无明显差异(P>0.05)。与Solitaire支架组比较,Trevo支架组的取栓时间更短[51(30～165)min vs 70(27～160)min,P<0.05]、取栓次数更少[2.1(1～6)次 vs 2.9(1～8)次,P<0.05]、取栓1次成功率更高(40.8% vs 27.5%,P<0.05)、TICI达2b或3级的血管再通率更高(89.8% vs 79.4,P<0.05)。发病到治疗时间≥360 min是影响术后并发症发生的独立危险因素(OR=1.084,95% CI=1.041～1.223,P=0.029),而血管再通TICI达2b或3级是预防术后并发症的独立保护性因素(OR=0.858,95% CI=0.761～0.977,P=0.016)。使用Trevo支架是促进血管再通的独立保护性因素(OR=0.722,95% CI=0.541～0.928,P=0.018,而取栓次数≥2次则是影响血管再通的独立危险因素(OR=1.460,95% CI=1.248～2.303,P=0.015)。结论 与Solitaire支架比较,Trevo支架能够减少AIS患者的取栓次数、缩短取栓时间,并提高闭塞血管的再通率和促进神经功能恢复。

The comparison of vascular recanalization between Trevo stent and Solitaire stent in acute ischemic stroke

ObjectiveTo compare the therapeutic efficiency of Trevo stent and Soliatire stent on revascularization and postoperative complications in acute ischemic stroke(AIS)underwent thrombectomy.Methods A retrospective enrollment of 200 patients with AIS who underwent stent thrombectomy in our hospital was divided into Solitaire stent group(102 cases)and Trevo stent group(98 cases)according to the type of stent used.The neurological outcomes were assessed by NIHSS score and modified Rankin scale(mRS).Revascularization was assessed by thrombolysis in cerebral infarction(TICI).The incidence of postoperative complications was compared.Logistics regression analysis was used to identift the independent risk factors that affect complications and revascularization after thrombectomy.Results The 30d NIHSS score in the Trevo group was significantly lower than that in the Solitaire group [3(0～13)vs 6(0～17),P<0.05],and the mRS score at 90d was also significantly lower in the Trevo group than that in the Solitaire group [2(0～5)vs.3(0～6),P<0.05].There was no significant difference in the incidence of postoperative stroke progression,distal thrombosis or embolization,postoperative hemorrhage,and death in two groups.Compared with the Solitaire stent group,the Trevo stent group had shorter thrombectomy time [51(30～165)min vs 70(27～160)min,P<0.05],and less thrombus times [2.1(1～6)] Times vs 2.9(1～8)times,P<0.05],higher one pass rate(40.8% vs 27.5%,P<0.05),and higher recanalization rate of TICI reached 2b or 3(89.8% vs 79.4,P<0.05).The time from onset to treatment ≥360 min was an independent risk factor for postoperative complications(OR=1.084,95% CI=1.041～1.223,P=0.029),and the recanalization of TICI to 2b or 3 was the independent protective factors for postoperative complications(OR=0.858,95% CI=0.761～0.977,P=0.016).The application of the Trevo stent was an independent protective factor for revascularization(OR=0.722,95% CI=0.541～0.928,P=0.018),and the number of thrombectomy≥2 was an independent risk factor for recanalization(OR=1.460,95% CI=1.248～2.303,P=0.015).Conclusion Compared with the Solitaire stent,the Trevo stent could reduce the number of thrombectomy in AIS patients,shorten the time of thrombectomy,increase the recanalization rate of infarct vessels and promote neurological recovery.