桥接治疗和单纯机械取栓治疗在前循环大血管闭塞中的应用研究

目的探讨急性前循环大血管闭塞时桥接治疗和单纯机械取栓治疗的临床疗效及安全性。方法回顾性分析2016-08—2019-10收住江西省人民医院神经内科的急性前循环大血管闭塞并行机械取栓或桥接治疗的患者55例,其中25例为桥接治疗,30例为单纯机械取栓治疗。通过比较2组患者基线资料、有效再灌注率、中位取栓次数、治疗有效率、并发症、院内死亡及功能结局(改良mRS评分),评估两种治疗方案的有效性和安全性。结果机械取栓组除高血压患病率较高(P=0.012)和起病至入院的时间较长(P<0.001)外,其余基线资料与桥接组比较无显著差异(P>0.05)。与治疗前相比,2组的再灌注率、治疗有效率、良好功能结局均明显上升(P<0.05),但2组间无显著性差异(P>0.05)。余2组在中位取栓次数、并发症、住院时间、住院费用、院内死亡和出院后90 d的全因死亡无显著性差异(P>0.05)。结论以支架取栓为基础的血管内治疗可为患者带来显著的临床疗效,对于因错过静脉溶栓时间窗或有其他静脉溶栓禁忌患者,单纯机械取栓治疗具有和桥接治疗相似临床疗效及安全性。

Study of bridging therapy and mechanical thrombectomy alone in acute anterior circulation large artery occlusion

Objective To investigate the clinical efficacy and safety of mechanical thrombectomy alone(MT)or bridging therapy(BT)in anterior circulation stroke due to large vessel occlusion(LVO).Methods Retrospective review of patients treated at the department of neurology in jiangxi provincial people's hospital between August 2016 and October 2019 that presented with acute ischemic stroke caused by anterior circulation large artery occlusion,and were treated with MT or BT.Of the 55patients,25(45%)were in MT group and 30(55%)were in BT group.Baseline characteristics,median number of passes,effective recanalization rate,effective rate,complications,intrahospital mortality,and functional outcomes(modified Rankin Scale(mRS))were compared between the two groups,in order to evaluate the efficacy and safety of the two treatment regimens.Results Baseline characteristics did not differ between the MT group and bridging cohort,except for higher rates of hypertension(P=0.012)and longer intervals from onset to admission(P<0.001)in the MT group.Compared with prior-treatment,the proportion of effective recanalization rate,effective rate,and favorable outcome were significantly increased in both groups(P<0.05),but there was not statistically significant difference between two groups(P>0.05).No significant difference was found in terms of median number of passes,complications,length of stay,hospitalization cost,intrahospital mortality,and in all cause mortality within 90 days.Conclusion Endovascular therapy of stent mechanical thrombectomy can bring significant clinical benefits to patients with acute anterior circulation large artery occlusion,and for those who unable to receive intravenous thrombolytic therapy due to miss time window or contraindications,receiving mechanical thrombectomy alone has similar clinical efficacy and safety as bridging therapy.