动脉内机械取栓治疗急性后循环缺血性脑卒中临床效果及预后影响因素

目的探讨机械取栓治疗急性后循环缺血性脑卒中患者的临床效果及预后影响因素。方法对15例急性后循环缺血性脑卒中患者行动脉内机械取栓治疗,统计血管成功再通率,并观察术后24 h内脑出血、脑梗死等不良反应发生情况。术后3个月随访,以改良Rankin量表(mRS)评估患者预后;对比预后良好(mRS评分0～2分)与不良(mRS评分3～6分)患者间基线资料及治疗相关指标的差异。结果对15例患者均成功开通闭塞血管,血管成功再通率100%(15/15)。术后24 h内1例发生脑出血,5例发生大面积脑梗死。术后3个月9例患者预后良好,5例预后不良,1例死亡。与预后不良患者比较,预后良好患者发病至入院时间更短(t=-2.435,P=0.030),入院时后循环Alberta卒中项目早期CT评分(pc-ASPECTS)更高(t=5.925,P0.001),术前美国国立卫生研究院卒中量表(NIHSS)评分更低(t=3.053,P=0.009)。结论动脉内机械取栓治疗急性后循环缺血性脑卒中效果好且安全性高;发病至入院时间、术前NIHSS评分及pc-ASPECTS是影响患者预后的因素。

Clinical efficacy and prognostic factors of mechanical thrombectomy in treatment of acute posterior circulation ischemic stroke

Objective To investigate the clinical efficacy and prognostic factors of mechanical thrombectomy in treatment of acute posterior circulation ischemic stroke. Methods Totally 15 patients with acute posterior circulation ischemic stroke were treated with mechanical thrombectomy. The successful recanalization rate and adverse reactions (such as intracerebral hemorrhage and infarction) within 24 hours after operation were observed. The prognosis was evaluated with modified Rankin scale (mRS) at 3 months for follow-up. The general data and the related indexes of treatment were compared between patients with good prognosis (mRS scores 0-2) and poor prognosis (mRS scores 3-6). Results The occluded vessels were recanalized successfully in all 15 patients (15/15, 100%). Within 24 hours after operation, 1 case occured cerebral hemorrhage, 5 cases had massive cerebral infarction. After 3 months, 9 patients had good prognosis and 5 patients had poor prognosis, 1 patient died. Compared with patients with poor prognosis, patients with good prognosis had shorter time from onset to admission (t=-2.435, P=0.030), higher posterior circulation-Alberta stroke prognosis early CT score (pc-ASPECTS) at admission (t=5.925, P<0.001) and lower National Institute of Health stroke scale (NIHSS) score before operation (t=3.053, P=0.009). Conclusion Intra-arterial mechanical thrombectomy is a safe and effective technique for treatment of acute posterior circulation ischemic stroke. Time from onset to admission, NIHSS score and pc-ASPECTS before operation are prognostic factors.