急性缺血性脑卒中患者支架取栓术中

目的 探讨替罗非班在急性缺血性脑卒中(acute ischemic stroke，AIS)患者支架取栓术中的疗效及安全性。方法 回顾性分析2015年12月至2017年8月经甘肃省人民医院脑血管病中心收治的因急性前循环大动脉闭塞性脑梗死而行支架取栓治疗患者的临床资料，共计66例，其中34例患者机械取栓中使用替罗非班(替罗非班组)，32例为单纯支架取栓(单纯支架取栓组)。采用脑梗死溶栓治疗后（thrombolysis incerebral infarction, TICI）血流分级来判断术后血管再通情况。采用海德堡出血分类标准评估术后出血转化情况，并评估术后症状性脑出血（symptomatic intracranial hemorrhage, SICH）。评估术后4小时、24小时、14天美国国立卫生研究院卒中量表(NIHSS)评分作为术后神经功能缺损情况依据。采用改良的Rankin评定量表（Modified Rankin Score, mRS）评估患者90天后日常活动中的残疾程度和独立能力。结果 术后替罗非班组TICI3级血流获得率、14天时NIHSS评分、治疗90天后mRS评分明显优于单纯支架取栓组（P＜0.05），两组术后血管再闭塞率、SICH发生率差异无统计学意义（P＞0.05）。结论 AIS患者支架取栓术中给予替罗非班治疗，有助于提高血管再灌注，改善预后，不增加出血风险，疗效良好，安全可行。

Efficacy and safety of tirofiban in mechanical thrombectomy for acute ischemic stroke

Objective To investigate the clinical efficacy and safety of tirofiban in stent thrombectomy for acute ischemic stroke. Methods A total of 66 patients with acute ischemic stroke who received endovascular sent mechanical thrombectomy in the Gansu Provincial Hospital Department of Cerebrovascular Disease Center were includedfrom December 2015 to August 2017 .They were divided into thrombectomy plus tirofiban group(n=32) and stent thrombectomy alone (n=34) . Postoperative blood perfusion of the two groups was evaluated by Thrombolysis Incerebral Infarction（TICI） blood flow fractionation. All patients underwent NIHSS score at 4 hours，24 hours and 14 days after operation. The Heidelberg Bleeding Classification was used to identify symptomatic intracrainal hemorrahage （SICH） after operation. The modified Rankin scale was used to evaluated the patients fuctional outcome after 3 months. Results The refusion TICI blood flow fractionation was increased after tirofiban treatment and the rate of TICI 3 stage blood flow of tirofiban group was significantly higher than that of the single embolectomy group(P＜0.05), and the NIHSS score at 14 days after operation of tirofiban group was significantly improved(P＜0.05), The mRS score was significantly improved in the tirofiban group compared with that in the simple stent thrombectomy group after 90 days (P＜0.05),No significant difference was found in reinfarction rate and symptomatic bleeding after operatione in two groups（P＞0.05）.Conclusion Tirofiban treatment during stent embolization in patients with AIS can improve vascular reperfusion and prognosis without increasing the risk of bleeding.