桥接法与直接取栓法治疗急性后循环缺血性卒中的疗效比较及预后影响因素分析

目的:探讨桥接法和直接取栓治疗急性后循环缺血性卒中患者的临床疗效、安全性以及预后影响因素。方法:回顾性研究。纳入2018年1月—2019年12月南阳市中心医院神经内科的急性后循环缺血性卒中患者67例，其中男52例、女15例，年龄51～74岁。按治疗方法不同分为两组：采用直接机械取栓治疗者34例纳入直接取栓组，采用静脉阿...

Clinical analysis of bridging thrombectomy and direct thrombectomy in the treatment of acute posterior circulation ischemic stroke

Objective This study aimed to explore the efficacy and safety of bridging therapy and direct thrombectomy in the treatment of acute posterior circulation ischemic stroke and analyze the prognostic factors.Methods This observational study involved 67 patients with acute posterior circulation ischemic stroke in Nanyang City Central Hospital from January 2018 to December 2019. The patients, who comprised 52 males and 15 females aged 51-74 years old, were received the treatment of direct thrombectomy or bridging therapy. The patients were divided into two groups according to different treatment methods. Thirty-four patients who received direct mechanical thrombectomy were included in the direct thrombectomy group, and 33 patients who received intravenous alteplase thrombolysis combined with mechanical thrombectomy and bridging were included in the bridging treatment group. Digital subtraction angiography was used to evaluate the vascular recanalization rate immediately after the operation, and the incidence of intracranial hemorrhage was evaluated by CT 48 hours after the operation. The modified Rankin scale (mRS) was used to evaluate the neurological recovery of the patients before and on the 90th day after the operation. The mortality rate within 90 days after operation was determined. The effectiveness and safety of the two treatment options were evaluated by comparing the clinical baseline data of the two groups of patients and the above-mentioned observation indicators. Multivariate logistic regression analysis was performed to screen independent risk factors for mortality within 90 days after surgery.Results The data from the two groups of patients were compared with clinical baseline data, such as age, gender distribution, preoperative National Institutes of Health stroke scale (NIHSS) score, etiology classification, onset time, and vascular occlusion location. The difference was not statistically significant (all P values＞0.05). The proportion of patients with atrial fibrillation in the bridging treatment group and direct thrombus removal combination was 9.1%(3/33) and 32.4%(11/34), respectively, and the difference was statistically significant (χ²=5.195, P＜0.05). The proportion of patients in the bridging treatment group with good neurological function recovery (mRS class 0-2) 90 days after surgery was higher than that in the direct thrombus removal group (51.5%[17/33] and 29.4%[10/34], respectively), but no significant difference was observed between the groups (χ²=3.401, P＞0.05). The postoperative vascular recanalization rate (75.8% vs. 58.8%) and mortality within 90 days after the operation were determined (27.3%[25/33] vs. 29.4%[10/34]), and no significant difference was noted between the two groups (P＞0.05). One patient (3.03%) in the bridging treatment group had intracranial hemorrhage 48 hours after surgery, whereas no intracranial hemorrhage was observed in the direct thrombus removal group. The difference between the two groups was not statistically significant (χ²=1.046, P＞0.05). Multivariate logistic regression analysis suggested that the NIHSS score at admission was an independent risk factor for mortality within 90 days after surgery.Conclusions Direct thrombectomy and bridging therapy have similar clinical efficacy and safety for acute posterior circulation ischemic stroke. The degree of neurological deficit at the onset has a certain correlation with the clinical prognosis.