单纯机械取栓术与动脉内复合方式治疗急性脑梗死的对比

目的比较单纯机械取栓术与动脉溶栓复合（支架置入、球囊扩张、机械碎栓）其他方式治疗急性脑梗死的疗效及安全性。方法回顾性分析包头市中心医院2004年1月—2012年1月治疗的急性脑梗死患者36例,其中17例采用动脉溶栓复合其他方式（简称复合治疗组）,对19例采用单纯机械取栓术（简称机械取栓组）。采用心肌梗死溶栓分级标准（TIMI）判断血管再通情况。比较两组的疗效及安全性。以P〈0.05为差异有统计学意义。结果①复合治疗组和机械取栓组血管再通患者比率分别为76.5%（13/17）、100%,P=0.025;残余狭窄率≤30%者,分别为11.8%（2/17）和47.4%（9/19）,P=0.021;治疗后24 h内,美国国立卫生研究院卒中量表（NIHSS）评分两组改善者分别为17.6%（3/17）和52.6%（10/19）,P=0.029。②治疗时,复合治疗组和机械取栓组栓子脱落发生率分别为5.9%（1/17）和5.3%（1/19）,P=0.935;穿支血管闭塞事件发生率分别为5.9%（1/17）和0,P=0.284。治疗后24 h内,症状性颅内出血发生率分别为11.8%（2/17）和10.5%（2/19）,P=0.906;两组均无患者发生治疗后急性血管再闭塞的情况;病死率分别为11.8%和10.5%,P=0.906。③治疗后3个月随访mRS≤1分者,复合治疗组和机械取栓组分别为52.9%（9/17）和89.5%（17/19）,P=0.015。结论单纯机械取栓术治疗急性脑梗死与动脉溶栓复合其他方法比较,安全性接近;但由于单纯机械取栓术的血管再通率高,短期效果可能要略好于动脉溶栓联合机械方法,但需要扩大样本量进一步证实。

Mechanical embolectomy alone versus intra-arterial bridge therapy for acute cerebral infarction

Objective To compare the efficacy and safety of intra-arterial thrombolysis combined with complex therapy(stenting,balloon dilatation,mechanical thrombectomy) and mechanical embolectomy alone in the treatment of acute cerebral infarction.Methods Thirty-six patients with acute cerebral infarction treated at Baotou Central Hospital from January 2004 to January 2012 were analyzed retrospectively.Among them,17 were treated with intra-arterial thrombolysis combined with complex therapy and 19 were treated with mechanical embolectomy alone.Thrombolysis in Myocardial Ischemia(TIMI) was used to identify the recanalization.The efficacy and safety of the two groups were compared.P<0.05 was considered as statistically significant.Results ①The recanalization rate of the intra-arterial thrombolysis combined with complex therapy group and the mechanical embolectomy group were 76.5%(13/17) and 100% respectively(P=0.025);the patients with residual stenosis rate ≤30% were 11.8%(2/17) and 47.4%(9/19) respectively(P=0.021).Within 24 hours after treatment,the improved NIHSS scores in patients of the 2 groups were 17.6%(3/17) and 52.6%(10/19) respectively(P=0.029).②During the treatment,the incidences of dislodgement of emboli in the intra-arterial thrombolysis combined with complex therapy group and the mechanical embolectomy group were 5.9%(1/17) and 5.3%(1/19) respectively(P=0.935);the incidences of perforator occlusion were 5.9% and 0 respectively(P=0.284).Within 24 hours after treatment,the incidences of symptomatic intracranial hemorrhage were 11.8% and 10.5% respectively(P=0.906).No patients had acute vascular reocclusion in both groups after treatment.The mortality rates were 11.8% and 10.5% respectively(P=0.906).③3-month follow-up after treatment,the patients with mRS ≤ 1 in the intra-arterial thrombolysis combined with complex therapy group and the mechanical embolectomy group were 52.9%(9/17) and 89.5%(17/19) respectively(P=0.015).Conclusion The safety of intra-arterial thrombolysis combined with complex therapy and the mechanical embolectomy alone in the treatment of acute cerebral infarction is similar.However,because the revascularization rate is high in the mechanical embolectomy alone group,its short-term effect may be slightly better than the intra-arterial thrombolysis combined complex therapy,but the sample size needs to be enlarge for further confirmation.