支架取栓治疗中重度院内急性缺血性卒中的效果分析

目的 探讨支架取栓术对伴有颅内外大血管病变的中重度院内急性缺血性卒中的疗效.方法 回顾性分析2012年9月至2017年5月在我院发生的、伴有颅内外大血管病变的中重度缺血性卒中患者的临床资料,其中12例行支架取栓治疗,15例行单纯药物治疗.对比支架取栓治疗与单独药物治疗前后美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)评分下降程度,评估3个月时改良RANKIN量表(mRS)评分,对比分析两组患者的疗效.结果 共纳入患者27例,其中12例进行了支架取栓治疗,术前NIHSS评分为(18.9±6.3)分,术后7 d NIHSS评分为(10.6±7.5)分,差异有统计学意义(P＜0.05);单纯药物治疗组用药前NIHSS评分为(12.7±4.2)分,治疗7d时NIHSS评分为(9.4±6.1)分,差异有统计学意义(P＜0.05).支架取栓组血管完全再通脑梗死溶栓分级(thrombolysis in myocardial infarction,TICI) 2b～3级]10例,部分再通(TICI 2a级)1例,未成功再通(TICI 0～1级)1例.术后3个月功能预后良好(mRS评分为0～2分):支架取栓组7例(占58.3％),单纯药物治疗组3例(占20.0％),2组差异有统计学意义(P＜0.05).结论 支架取栓治疗可明显增加伴有大血管病变的中重度院内缺血性卒中患者的血运重建率,降低患者的致残率,促进患者神经功能恢复.

Efficacy of mechanical thrombectomy with stent retriever for moderate to severe in-hospital acute ischemic stroke patients

Objective To investigate the efficacy of mechanical thrombectomy with stent retriever for moderate to severe acute ischemic stroke patients hospitalized due to intracranial and extracranial large artery disease.Methods We retrospectively analyzed angiographic and clinical data from 27 consecutive moderate to severe in-hospital ischemic stroke patients who admitted in our hospital due to intracranial and extracranial large artery disease between September 2012 and May 2017.Mechanical thrombectomy was performed in 12 patients,and the other 15 patients only received medication treatment.The scores of National Institutes of Health Stroke Scale (NIHSS) before and after treatment were compared,and the difference was compared between the 2 approaches.The modified Rankin Scale (mRS) was employed to evaluate the efficacy of mechanical thrombectomy and drug treatment in 3 months later.Results In the 12 patients undergoing mechanical thrombectomy,the NIHSS score was decreased from 18.9 ±6.3 before operation to 10.6 ±7.5 in 7 d after (P ＜ 0.05),and 10 of them obtained complete recanalization (thrombolysis in myocardial infarction,TICI 2b～3),and 1 only got partially recanalized (TICI 2a),and 1 failed (TICI 0～1).In 3 months after treatment,there were 7 patients (58.3％) from mechanical thrombectomy group achieving sound functional independence (mRS 0 ～ 2),while only 3 cases (20％) in the medication group,with significant difference between the 2 groups (P ＜ 0.05).Conclusion For the moderate to severe in-hospital ischemic stroke patients caused by large artery disease,mechanical thrombectomy with stent retriever can increase revascularization,reduce disability and promote the recovery of nerve function.