直接动脉取栓和静脉溶栓后桥接动脉取栓治疗急性大动脉闭塞性脑梗死疗效分析
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摘要
目的比较急性大动脉闭塞性脑梗死患者直接动脉取栓和静脉溶栓后桥接动脉取栓的疗效。方法将2016年1月至2017年12月于我院就诊的66例急性大动脉闭塞性脑梗死患者分为直接动脉取栓组与静脉溶栓后桥接动脉取栓组(动脉取栓26例,静脉溶栓后桥接动脉取栓40例),分别使用相应的方案治疗,对比观察两组血管再通率、术后病死率、再出血风险以及治疗前后早期神经功能恶化(END),及应用Rankin量表(mRS)评价术后3个月预后。结果与直接动脉取栓组血管再通19例(73. 07%)、END10例(38. 46%)、3个月mRS评分(2. 73±1. 78)比较,静脉溶栓后桥接动脉取栓组血管再通29例(72. 50%)、END13例(32. 50%)无明显差异(P>0. 05),3个月mRS评分(1. 90±1. 46)明显降低(P<0. 05);与直接动脉取栓组出血3例(11. 54%)及死亡1例(3. 84%)比较,静脉溶栓后桥接动脉取栓组出血6例(15. 00%)及死亡2例(5. 00%)无明显差异(P>0. 05)。结论对于急性大动脉闭塞性脑梗死患者,静脉溶栓后桥接动脉取栓疗效优于直接动脉取栓,且没有增加出血及死亡率。
Objective To compare the effects of direct intra-artery throbectomy and that combined with intravenous thrombolysis on acute cerebral infarction( ACI) with large cerebral artery occlusion.Methods 66 ACI cases with large cerebral artery occlusion during the period from Jan.,2016 to Dec.,2017 were divided,according to different treatments applied,into 2 groups: direct group( direct intra-artery throbectomy applied,n = 26) and combined group( intra-artery throbectomy combined with intravenous thrombolysis applied,n = 40); the blood vessel re-canalization rate,postoperative mortality,risk of rebleeding,and pre-and post-operative early neurological deterioration( END)were observed and the modified Rankin scale( mRS) was applied in evaluating the prognosis at the time point of 3 months after operation.Results There existed no obvious differences in blood vessel recanalization rate and END between direct group [(19 cases(73. 07%),10 cases(38. 6%)]and combined group [29 cases(72. 50%),13 cases(32. 50%)](P>0. 05) while the mRS score 3 months after operation in combined group(1. 90±1. 46) was much lower than that in direct group( P<0. 05); bleeding occurred in 3 cases(11. 54%) and death in 1 case(3. 84%) in direct group while bleeding occurred in 6 cases(15. 00%) and death in 2 cases(5. 00%),the difference between the2 groups was of no obvious significance( P>0. 05).Conclusions Intra-artery throbectomy combined with intravenous thrombolysis is of better effect than direct intra-artery throbectomy on ACI with large cerebral artery occlusion,leading to no more bleeding or a higher mortality.
Objective To compare the effects of direct intra-artery throbectomy and that combined with intravenous thrombolysis on acute cerebral infarction( ACI) with large cerebral artery occlusion.Methods 66 ACI cases with large cerebral artery occlusion during the period from Jan.,2016 to Dec.,2017 were divided,according to different treatments applied,into 2 groups: direct group( direct intra-artery throbectomy applied,n = 26) and combined group( intra-artery throbectomy combined with intravenous thrombolysis applied,n = 40); the blood vessel re-canalization rate,postoperative mortality,risk of rebleeding,and pre-and post-operative early neurological deterioration( END)were observed and the modified Rankin scale( mRS) was applied in evaluating the prognosis at the time point of 3 months after operation.Results There existed no obvious differences in blood vessel recanalization rate and END between direct group [(19 cases(73. 07%),10 cases(38. 6%)]and combined group [29 cases(72. 50%),13 cases(32. 50%)](P>0. 05) while the mRS score 3 months after operation in combined group(1. 90±1. 46) was much lower than that in direct group( P<0. 05); bleeding occurred in 3 cases(11. 54%) and death in 1 case(3. 84%) in direct group while bleeding occurred in 6 cases(15. 00%) and death in 2 cases(5. 00%),the difference between the2 groups was of no obvious significance( P>0. 05).Conclusions Intra-artery throbectomy combined with intravenous thrombolysis is of better effect than direct intra-artery throbectomy on ACI with large cerebral artery occlusion,leading to no more bleeding or a higher mortality.
引文
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[4]TILLEY B C,LYDEN P D,BROTT T G,et al.Total quality improvement method for reduction of delays between emergency department admission and treatment of acute ischemic stroke.The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group.[J].Archives of Neurology,1997,54(12):1466-74.
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[6]何子骏,罗永春,张振海,等.Solitaire AB支架机械取栓治疗后循环急性缺血性卒中[J].中华外科杂志,2016,54(5):340-345.
[7]DESILLES J P,LOYAU S,SYVANNARATH V,et al.Alteplase Reduces Downstream Microvascular Thrombosis and Improves the Benefit of Large Artery Recanalization in Stroke[J].Stroke,2015,46(11):3241-3248.
[8]李桂林,杜世伟,李静伟,等.静脉溶栓桥接动脉内取栓治疗颅内大血管急性闭塞的效果分析[J].中国脑血管病杂志,2017,14(03):122-126.
[9]韩霞.纤溶酶原激活剂治疗急性脑梗死的疗效分析[J].陕西医学杂志,2016,45(8):1086-1087.
[10]江天丽,马烈,傅新民,等.常规时间窗与扩大时间窗动、静脉联合溶栓治疗急性脑梗死临床疗效的对比研究[J].实用心脑肺血管病杂志,2017,25(3):65-68.
[2]张小雪,张京芬.国内急性期缺血性脑卒中的溶栓治疗现状分析[J].中华老年心脑血管病杂志,2015,(2):222-224.
[3]ALMENAWER S A,NASSIRI F,BADHIWALA J H.Endovascular Thrombectomy for Acute Ischemic Stroke A Meta-Analysis[J].Journal of the American Medical Association,2015,314(17):1832-43.
[4]TILLEY B C,LYDEN P D,BROTT T G,et al.Total quality improvement method for reduction of delays between emergency department admission and treatment of acute ischemic stroke.The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group.[J].Archives of Neurology,1997,54(12):1466-74.
[5]陈荣华,彭亚,宣井岗,等.缺血性卒中急性期Solitaire AB支架机械取栓术的效果[J].中国脑血管病杂志,2013,(12):620-624.
[6]何子骏,罗永春,张振海,等.Solitaire AB支架机械取栓治疗后循环急性缺血性卒中[J].中华外科杂志,2016,54(5):340-345.
[7]DESILLES J P,LOYAU S,SYVANNARATH V,et al.Alteplase Reduces Downstream Microvascular Thrombosis and Improves the Benefit of Large Artery Recanalization in Stroke[J].Stroke,2015,46(11):3241-3248.
[8]李桂林,杜世伟,李静伟,等.静脉溶栓桥接动脉内取栓治疗颅内大血管急性闭塞的效果分析[J].中国脑血管病杂志,2017,14(03):122-126.
[9]韩霞.纤溶酶原激活剂治疗急性脑梗死的疗效分析[J].陕西医学杂志,2016,45(8):1086-1087.
[10]江天丽,马烈,傅新民,等.常规时间窗与扩大时间窗动、静脉联合溶栓治疗急性脑梗死临床疗效的对比研究[J].实用心脑肺血管病杂志,2017,25(3):65-68.