急性前循环缺血性脑卒中取栓治疗患者的临床特点及预后
叶 立 杨卫民 王水平
安徽医科大学第一附属医院，安徽 合肥 230022
通信作者：叶立
【摘要】 目的 分析急性前循环缺血性脑卒中取栓治疗患者的临床特点及预后。方法 回顾性纳入 2020-06—2021-09 安徽医科大学第一附属医院取栓治疗的急性前循环缺血性脑卒中患者，共入组 71 例患者，分别接受直接取栓或桥接治疗（静脉溶栓后桥接取栓治疗）。分析所有患者的人口学资料、脑血管病高危因素、美国国立卫生研究院卒中量表（NIHSS）评分、是否静脉溶栓、卒中 TOAST 分型、闭塞部位及影像学资料。患者临床预后的评估使用 90 d 改良 Rankin 量表（mRS），并发症的主要评估指标是术后24 h 症状性颅内出血。结果 直接取栓患者 42 例，占 59.2%，桥接治疗患者 29 例，占 40.8%。大动脉粥样硬化型和心源性栓塞型是最主要的 TOAST 分型，分别占 52.1%和 35.2%。大动脉粥样硬化型患者和心源性栓塞型患者基线 NIHSS 评分、静脉溶栓比例及闭塞部位差异无统计学意义（P>0.05），术后 24 h 症状性颅内出血（SICH）发生率、预后良好比例（mRS≤2）及 90 d 病死率（mRS=6）差异无统计学意义（P>0.05）。直接取栓患者与桥接治疗患者在 SICH 发生率、预后良好比例及 90 d 病死率上差异无统计学意义（P>0.05）。结论 取栓治疗是急性前循环缺血性脑卒中的一项有效治疗方法，大脉粥样硬化型及心源性栓塞型患者取栓治疗以及直接取栓与桥接治疗的有效性及安全性无差异。
【关键词】 缺血性脑卒中；取栓治疗；静脉溶栓；桥接治疗；临床特点
【中图分类号】 R743.33 【文献标识码】 A 【文章编号】 1673-5110 （2022） 05-0534-06
基金项目：2017 年中国脑卒中高危人群干预适宜技术研究及推广项目（编号：GN-2017R0001）
DOI：10.12083/SYSJ.220324
Clinical features and prognosis of endovascular thrombectomy in patients with acute anterior circulation ischemic stroke
YE Li，YANG Weimin，WANG Shuiping
The First Affiliated Hospital of Anhui Medical University，Hefei 230022，China
Corresponding author：YE Li
【Abstract】 Objective To evaluate the clinical features and prognosis of endovascular thrombectomy in patients with acute anterior circulation ischemic stroke. Methods Patients with acute precirculation ischemic stroke treated by thrombectomy in the First Affiliated Hospital of Anhui Medical University from June 2020 to September 2021 were retrospectively enrolled. A total of 71 patients with acute anterior circulation ischemic stroke were enrolled，and all patients were divided into group treated with mechanical thrombectomy alone and group treated with mechanical thrombectomy after intravenous thrombolysis. Demographic and clinical information about risk factors for cerebrovascular disease，the United States National Institutes of Health stroke scale（NIHSS） score，whether or not intravenous thrombolysis，vessel occlusion location，stroke etiology classification and imaging data were evaluated. 90-day modified Rankin scale（mRS） score was used to evaluate clinical prognosis，and the symptomatic intracranial hemorrhage（SICH） within 24 hours was used as a primary index for safety assessment. Results Direct endovascular treatment was performed in 42 patients（59.2%） and bridging therapy was performed in 29 patients（40.8%）. Large artery atherosclerosis and cardioembolism were the most TOAST types，accounting for 52.1% and 35.2%，respectively. There were no significant differences in baseline NIHSS score，intravenous thrombolysis ratio and occlusion site between patients with large artery atherosclerosis and patients with cardioembolism （P>0.05）. There were no significant differences in the incidence of symptomatic intracranial hemorrhage （SICH） 24 hours after operation，proportion of good prognosis （mRS≤2） and 90-day mortality （mRS=6）（P>0.05）. There were no significant differences in the incidence of SICH，the proportion of good prognosis and 90-day mortality between patients with direct endovascular treatment and those with bridging therapy （P>0.05）. Conclusion Endovascular thrombectomy is one effective treatment for patients with acute anterior circulation ischemic stroke，and there is no difference in the safety and effectiveness between bridging therapy and direct mechanical thrombectomy as well as between large artery atherosclerosis patients and patients with cardioembolism treated with endovascular thrombectomy.
【Key words】 Ischemic stroke；Thrombectomy；Intravenous thrombolysis；Bridging therapy；Clinical features
