机械取栓和支架植入治疗动脉粥样硬化性颅内大血管闭塞疗效对比研究

目的对比机械取栓和支架植入两种血管内治疗方式对动脉粥样硬化性颅内急性大血管闭塞导致的急性缺血性卒中的疗效差异。方法回顾性分析我中心接受血管内治疗的颅内动脉粥样硬化性大血管闭塞导致的急性缺血性卒中患者,可回收支架组使用可回收支架取栓治疗作为第一治疗措施合并或不合并其他补救措施,支架植入组采取支架植入作为血管再通方式,比较两组患者再通率、临床预后及并发症情况等。结果共计64例患者纳入本研究,其中可回收支架组48例,支架植入组16例。可回收支架组初次使用可回收支架取栓后再通率仅仅为18.75%,37例接受了补救性治疗措施,两组最终再通率未见明显差异(P=0.566)。与可回收支架组相比,支架植入组术中操作时间明显较短(P0.01),两组患者术后48 h神经功能改善情况(P=0.885)、围手术期出血并发症(P=0.817)未见差异,术后3个月良好预后(P=0.884)以及死亡率(P=0.874)情况未见明显差异。结论对于动脉粥样硬化性大血管闭塞导致的急性缺血性卒中,单独使用可回收支架取栓效果欠佳,往往需要其他补救性治疗措施,直接支架植入治疗也是一种有效的治疗方式。

Comparative Study on Efficacy of Stent Retrieval and Stent Placement in the Treatment of Large Artery Occlusion due to Intracranial Atherosclerotic Disease

Objective To evaluate the efficacy of stent retrieval and stent placement in the treatment of large artery occlusion due to intracranial atherosclerotic disease (IAD). Methods Patients with acute large artery occlusion due to IAD underwent endovascular treatment in our center were performed retrospective analysis and divided into two groups. In the stent retrieval group, patients received stent retrieval as first method with or without other rescue treatment, and in the stent placement group, patients received stent placement as first method without other treatment. The recanalization rate, clinical outcome and procedure details between two groups were compared. Results A total of 64 patients were enrolled into study. Among which, 48 cases with large intracranial artery occlusion due to IAD were enrolled in the stent retrieval group and 16 cases were enrolled in the stent placement group. The initial recanalization rate was significantly lower (18.75%) with stent retriever as first method in the stent retrieval group, and 37 patients received one (or more) adjunctive treatment. The final rate of recanalization was comparable among two groups (P=0.566). The procedure time was significantly shorter in the stent placement group than in the stent retrieval group (P<0.01) neurological improvement in 48 hours (P=0.885) and sICH preprocedure (P=0.817) werecomparable. The mortality (P=0.874) and good outcome in the 90 days (P=0.884) were comparable between two groups. Conclusion Among patients with acute large artery occlusion due to IAD, endovascular treatment with stent retriever cannot achieve satisfactory effect and usually requires other corrective treatment measures. Direct stent placement is also a kind of effective therapeutic method.