4～6h时间窗内急性脑梗死患者行机械开通的疗效分析

目的评价发病4~6h机械开通治疗急性脑梗死的疗效及安全性。方法对2015-06—2016-12在我科住院的发病4~6h时间窗内的187例急性脑梗死患者进行回顾性分析,患者全部行脑血管造影检查明确病因,对大血管闭塞患者行单纯支架取栓治疗,统计血管再通情况及分析临床疗效。结果介入治疗术后M2段闭塞共17例(12例再通),M1段闭塞共58例(52例再通),颈内动脉末端闭塞(T型)共9例(4例再通),床突段闭塞共7例(1例再通),颈内动脉大负荷量血栓共15例(10例再通),椎基底动脉闭塞共28例(24例再通)。M2段闭塞患者治疗1周以后病情较术前明显好转(P0.05),M1段闭塞的患者在术后1d就出现明显好转(P0.01),椎基底动脉闭塞的患者术后第1天就出现明显好转(P0.05)。1个月后mRS 1~3分的患者中M2段闭塞占88%,M1段闭塞占60%,颈内动脉末端闭塞(T型)占11%,床突段闭塞占14%,颈内动脉大负荷量血栓占7%,椎基底动脉闭塞占39%。结论发病4~6h时间窗内行机械取栓血管再通治疗安全有效,大部分患者的闭塞动脉能及时再通,临床疗效显著。

Analysis of curative effect of endovascular thrombectomy(EVT)for acute ischemic stroke within 4-6 hours time window

Objective To evaluate the efficacy and safety of mechanical thrombectomy in the treatment of acute cerebral infarction (4-6 hours).Methods From June 2015 to December 2016 in our hospital onset 4-6 hours within the time window of 187 cases of acute cerebral infarction patients were analyzed retrospectively.All patients underwent cerebral angiography to define the cause of vascular occlusion patients underwent stent thrombectomy,statistical analysis of vascular recanalization and clinical curative effect.Results After interventional therapy,M2 segment occlusion in 17 cases (12 cases recanalization),M1 segment occlusion in 58 cases (52 cases recanalization),carotid terminus occlusion (T) in 9 cases (4 cases recanalization),clinoid segment occlusion in 7 cases (1 case recanalization),complete occlusion of internal carotid artery in 15 cases (10 cases recanalization),vertebral basilar artery occlusion in 28 cases (24 cases recanalization).Occlusion of the M2 segment of patients after 1 week of treatment was significantly improved compared with preoperative (P<0.05),M1 occlusions in patients after 1 day showed a significant improvement (P<0.01),vertebral basilar artery occlusion in patients after first day showed a significant improvement (P<0.05).mRS score 1-3 after one month in patients with M2 segment occlusion accounted for 88%,M1 segment occlusion accounted for 60%,carotid terminus occlusion (T) accounted for 11%,clinoid segment of internal carotid artery occlusion accounting for 14%,complete occlusion of internal carotid artery accounted for 7%,vertebral basilar artery occlusion accounting for 39%.Conclusion It is safe and effective in the treatment of 4-6 hours time window for endovascular mechanical thrombectomy,and most of the patients can improve the clinical efficacy.