急性颅内大动脉粥样硬化与栓塞性缺血脑卒中机械取栓治疗的对比研究
李家辉 陈巨罗 李子峰 王国防 王福星 王幼萌
蚌埠医学院附属阜阳医院 阜阳市人民医院，安徽 阜阳 236000
通信作者：王幼萌
【摘要】 目的 对比分析血管内机械取栓治疗颅内大动脉粥样硬化性（ICAS）和栓塞性（embolic）急性缺血性脑卒中的临床效果和安全性。方法 回顾性分析 2019-01—2021-12 采用血管内机械取栓治疗的 118 例急性大血管闭塞的缺血性脑卒中患者的临床资料，其中 ICAS 组 27 例（22.9%），Embolic 组 91 例（77.1%）。结果 与 Embolic 组比较，ICAS 组更高的后循环闭塞比例（37.0% vs 14.3%，P=0.009）、更高的球囊扩张（66.7% vs 7.7%，P<0.001）及支架置入比例（59.3% vs 6.6%，P<0.001），手术时间明显延长［110.00（80.00~130.00）min vs 85.00（55.00~120.00）min，P=0.021）］，年龄更小［（63.67±11.48）岁 vs（68.25±10.13）岁，P=0.047］，合并冠心病比例（14.8% vs 41.8%，P=0.010）、心房颤动比例（7.4% vs 52.7%，P<0.001）及术后出血发生率（3.7% vs 23.1%，P=0.023）明显降低，2 组血管成功再通率（92.6% vs 91.2%）及术后 3 个月预后良好率（40.7% vs 49.5%）均无统计学差异（P>0.05）。结论 对比颅内动脉粥样硬化与栓塞性急性缺血性脑卒中，危险因素存在差异，ICAS 组术后出血发生率明显降低，且术中往往需要联合血管成形术，但两者预后无明显差异。
【关键词】 脑卒中；颅内动脉硬化；栓塞；机械取栓
【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1673-5110 （2022） 07-0846-05
基金项目：中国卒中学会脑血管病全程管理项目启航基金（编号：2020017）
DOI：10.12083/SYSJ.220582
Comparative study of mechanical thrombectomy in the treatment of intracranial large atherosclerotic and embolic acute ischemic stroke
LI Jiahui，CHEN Juluo，LI Zifeng，WANG Guofang，WANG Fuxing，WANG Youmeng
Fuyang Hospital Affiliated to Bengbu Medical College/Fuyang People’s Hospital，Fuyang 236000，China
Corresponding author：WANG Youmeng
【Abstract】 Objective To compare and analyze the clinical effect and safety of intravascular mechanical thrombectomy in the treatment of intracranial large atherosclerotic（ICAS）and embolic acute ischemic stroke. Methods The clinical data of 118 ischemic stroke patients with acute large vessel occlusion treated by intravascular mechanical thrombectomy from January 2019 to December 2021 were analyzed retrospectively，including 27 cases（22.9%）in ICAS group and 91 cases（77.1%）in embolic group. Results Compared with embolic group，ICAS group had higher posterior circulation occlusion ratio（37.0% vs 14.3%，P=0.009），higher balloon dilatation ratio（66.7% vs 7.7% ，P<0.001）and stent implantation ratio（59.3% vs 6.6%，P<0.001），significantly longer operation time（110.00（80.00-130.00）min vs 85.00（55.00-120.00）min，P=0.021），and younger age（（63.67±11.48）years old vs （68.25±10.13）years old，P=0.047），The ratio of coronary heart disease （14.8% vs 41.8% ，P=0.010），the ratio of atrial fibrillation（7.4% vs 52.7% ，P<0.001）and the incidence of postoperative bleeding（3.7% vs 23.1%，P=0.023）were significantly reduced. There was no significant difference between the two groups in the successful recanalization rate（92.6% vs 91.2%）and the good prognosis rate at 3 months after operation（40.7% vs 49.5%）（P>0.05）. Conclusion There are differences in risk factors between intracranial atherosclerosis and embolic acute ischemic stroke. The incidence of postoperative hemorrhage in ICAS group is significantly reduced，and angioplasty is often required during operation，but there is no significant difference in prognosis between the two groups.
【Key words】Storke；Intracranial arteriosclerosis；Embolism；Mechanical thrombectomy
