房颤致大脑中动脉闭塞急性缺血性脑卒中动脉支架取栓治疗的临床研究

目的探讨房颤栓子导致大脑中动脉闭塞引起急性缺血性脑卒中患者动脉支架取栓治疗的预后。方法回顾性分析我院2014年6月～2017年12月房颤栓子致急性大脑中动脉闭塞脑卒中行急诊取栓患者34例(房颤组),其他原因致急性大脑中动脉闭塞行急诊取栓患者48例(非房颤组)。对两组患者的年龄、性别、高血压病史、糖尿病史、INR、NIHSS评分、发病到再灌注时间(TOR)、手术时间、取栓次数、有效再通率、术后再出血、术后去骨瓣减压、术后7 d NIHSS评分、术后90 d mRS评分进行分析,分析房颤致大脑中动脉闭塞急性缺血性脑卒中动脉支架取栓治疗的临床特点和预后。结果房颤组与非房颤组在年龄、性别、高血压病史、糖尿病史组成方面无明显差异,房颤组术前NIHSS评分及术前INR均显著高于非房颤组,房颤组平均手术时间及平均取栓次数均少于非房颤组;两组患者在TOR、有效再通率、术后再出血、去骨瓣减压方面均无显著性差异。非房颤组在术后7 d NIHSS改善总有效率和术后90 d mRS恢复良好率上优于房颤组,但是在细分亚组中均无显著优势。结论房颤性大脑中动脉闭塞急性缺血性卒中患者入院时病情相对较重,动脉支架取栓治疗该类患者效果良好,不明显增加术后并发症,近期临床功能恢复基本满意。

Clinical study of arterial stent thrombectomy in the treatment of acute ischemic stroke induced by middle cerebral artery occlusion caused by atrial fibrillation

Objective To investigate the prognosis of arterial stent thrombectomy in the patients with acute ischemic stroke induced by middle cerebral artery occlusion caused by atrial fibrillation embolus.Methods A retrospective analysis were carried out for 34 patients(atrial fibrillation group)who were given emergency thrombectomy for acute middle cerebral artery occlusion stroke induced by atrial fibrillation embolus from June 2014 to December 2017 in our hospital,as well as 48 patients who were given emergency thrombectomy due to other causes of acute middle cerebral artery occlusion(non-atrial fibrillation group).Age,gender,history of hypertension,history of diabetes,INR score,NIHSS score,time from onset to reperfusion(TOR),time of surgery,number of thrombectomy,rate of effective recanalization,postoperative rebleeding,postoperative decompressive craniectomy,NIHSS score 7 days after surgery,and mRS score 90 days after surgery were analyzed in both groups of patients.The clinical features and prognosis of arterial stent thrombectomy in the treatment of acute ischemic stroke induced by middle cerebral artery occlusion caused by atrial fibrillation were analyzed.Results There was no significant difference in the composition of age,gender,history of hypertension,and history of diabetes between the atrial fibrillation group and the non-atrial fibrillation group.The preoperative NIHSS score and preoperative INR were significantly higher in the atrial fibrillation group than in the non-atrial fibrillation group.The average surgery time and average number of thrombectomy in the atrial fibrillation group were less than those in the non-atrial fibrillation group;there were no significant differences between the two groups in terms of TOR,rate of effective recanalization,postoperative rebleeding,and decompressive craniectomy.The non-atrial fibrillation group was superior to the atrial fibrillation group in the total effective rate of NIHSS improvement and the good rate of mRS recovery at 90 days after surgery.However,there were no significant advantages in the subgroups.Conclusion Patients with acute ischemic stroke induced by middle cerebral artery occlusion caused by atrial fibrillation are relatively severe upon admission.Arterial stent thrombectomy for this type of patients is effective,which does not significantly increase postoperative complications,and the short-term clinical functional recovery is basically satisfactory.