静脉溶栓桥接动脉内取栓治疗颅内大血管急性闭塞的效果分析

目的探讨静脉溶栓桥接动脉内取栓开通颅内大血管急性闭塞的安全性和有效性。方法回顾性分析首都医科大学宣武医院2016年1月至9月采用静脉溶栓桥接动脉内取栓模式治疗的63例颅内大血管急性闭塞患者的临床资料,静脉溶栓开始时间在发病≤4.5 h,血管内治疗开始时间(股动脉穿刺)在发病≤6 h。根据取栓方式将其分为单纯支架取栓组(41例)和支架联合抽吸取栓组(22例),两组患者在性别构成、平均年龄、闭塞部位及入院美国国立卫生研究院卒中量表(NIHSS)评分方面差异无统计学意义(均P0.05)。采用改良脑梗死溶栓试验(m TICI)评价血管开通效果,分析静脉桥接下两种动脉内治疗方式的血管再通时间,取栓次数,入院时、术后72 h和90 d的NIHSS评分,术中及术后并发症发生情况。结果 (1)单纯支架取栓组中,前循环闭塞37例(90.2%),后循环闭塞4例(9.8%);支架联合抽吸取栓组中,前循环闭塞20例(90.9%),后循环闭塞2例(9.1%),组间差异无统计学意义(P0.05)。治疗后患者大血管均获得良好开通(m TICI分级:Ⅱb~Ⅲ级)。(2)单纯支架取栓组血管平均再通时间为(86±11)min,平均动脉取栓次数为(2.8±0.9)次;术后并发症发生率为14.6%(症状性出血5例,心源性死亡1例),90 d随访mRS(0~2分)患者占51.2%(21/41)。支架联合抽吸取栓组血管平均再通时间为(83±11)min,平均动脉取栓次数为(2.2±0.8)次,术后并发症发生率为13.6%(症状性出血2例,心源性死亡1例),90 d随访mRS(0~2分)患者占59.1%(13/22)。两组以上指标比较,差异均有统计学意义(均P0.05)。结论静脉溶栓桥接单纯支架取栓和支架联合抽吸取栓均能快速使颅内闭塞大血管获得再通,并且支架联合抽吸取栓具有更好的再通率。但两种技术在改善患者临床预后方面尚有待进一步研究。

Efficacy analysis of intravenous thrombolysis bridging intra-arterial thrombectomy for the treatment of acute intracranial large-vessel occlusion

Objective To investigate the safety and effectiveness of intravenous thrombolysis bridging intra-arterial thrombectomy for opening the acute occlusion of intracranial large artery.Methods Theclinical data of 63 patients with acute intracranial large artery occlusion treated with intravenous thrombolysis bridging intra-arterial thrombectomy in Beijing Xuanwu Hospital,Capital Medical University from January to September 2016 were analyzed retrospectively. The initiation time of intravenous thrombolysis was within 4. 5 h after onset. The initiation time of endovascular therapy (femoral artery puncture)was within 6 h after onset. They were divided into either a simple stent mechanical thrombectomy group (n=41)or a stent mechanical thrombectomy combined with catheter suction group (n=22)according to the ways of thrombectomy. There were no significant differences in the gender composition,average age,occlusion site and National Institutes of Health Stroke Scale (NIHSS)score on admission between the two groups of patients (all P <0. 05). The modified Thrombolysis in Cerebral Infarction (mTICI)was used evaluate the effect of vascular patency. The vascular recanalization time,number of thrombectomy,NIHSS scores on admission,at 72 h after procedure and at day 90,and intraoperative and postoperative complications treated with two kinds of intra-arterial treatment under the intravenous thrombolysis bridging were analyzed. Results (1)In the simple stent mechanical thrombectomy group,there were 37 patients with anterior circulation occlusion (90. 2%)and 4 with posterior circulation occlusion (9. 8%). In the stent mechanical thrombectomy combined with catheter suction group, there are 20 patients with anterior circulation occlusion (90. 9%)and 2 with posterior circulation occlusion (9. 1%). There were no significant differences between the two groups of patients (P<0. 05). After treatment, the large vessels achieved good recanaliazation (mTICI grade:Ⅱb-Ⅲ). (2)The mean recanalization time of the simple stent mechanical thrombectomy group was 86 ± 11 min and the mean number of arterial embolectomy was 2. 8 ± 0. 9 times. The complication rate after procedure was 14. 6%(5 symptomatic intracranial hemorrhages and 1 cardiac death). The patients of mRS 0-2 accounted for 51. 2%(21/41)at 90 days of follow-up. The mean recanalization time of the stent mechanical thrombectomy combined with catheter suction group was 83 ± 11 min and the mean number of arterial embolectomy was 2. 2 ± 0. 8 times. The compli-cation rate after procedure was 13. 6%(2 symptomatic intracranial hemorrhages and 1 cardiac death). The patients of mRS 0-2 accounted for 59. 1%(13/22)at 90 days of follow-up. There were significant differ-ences in the above indices between the two groups(all P<0.05).Conclusion Both intravenous throm-bolysis bridging simple stent mechanical thrombectomy and stent mechanical thrombectomy combined with catheter suction can quickly make the recanalization of intracranial occlusion of large artery,and the stent mechanical thrombectomy combined with catheter suction has a better recanalization rate. However, both techniques need to be further studied in improving the clinical prognosis of patients.