动脉粥样硬化性脑梗死和心源性脑梗死机械取栓治疗的比较

The comparison of mechanical thrombectomy treatment for patients with large artery atherosclerosis stroke and cardiac embolism stroke

目的探讨动脉粥样硬化性脑梗死(LAA)和心源性脑梗死(CE)机械取栓治疗的差异和疗效。方法回顾分析2017年6月-2018年8月行机械取栓治疗的脑梗死患者33例,比较2组患者的危险因素、闭塞的血管、侧支循环、取栓次数、从股动脉穿刺至血管再通的时间、取栓后补救措施和血管再通的程度,并评估NIHSS评分、mRS评分和术后并发症。结果CE组的冠心病(或风心病)、房颤病史比例高于LAA组(P<0.05);LAA组侧支循环良好率为43.48%,高于CE组的10%(P=0.045);CE组从动脉穿刺到血管再通的时间、取栓的次数均<LAA组,而取栓后mTICI评分达到良好灌注的比例又远高于后者(P<0.05);2组患者术前和术后3月的NIHSS评分、mRS评分比较均无明显差异(P>0.05);2组开通后再闭塞、脑出血和病死率也无统计学差异(P>0.05)。结论相比动脉粥样硬化性脑梗死,心源性脑梗死患者行取栓治疗需要更短的开通时间、更少的取栓次数、得到更好的血流灌注,但2组最终的预后相似。

Objective To evaluate the differences and effects of mechanical thrombectomy treatment for patients with large artery atherosclerosis stroke and cardiac embolism stroke.Methods The clinical data of 33 patients with stroke from June 2017 to August2018 were analyzed retrospectively.The differences of risk factors, occlusive vessels,cerebral collateral circulation,number of thrombectomy,time from femoral artery puncture to vascular recanalization,remedial measures after embolectomy and the effect of vascular patency were compared between the two groups.NIHSS scores,mRS scores and postoperative complications were also analyzed in two groups.Results The ratio of heart disease in CE group was higher than that in group LAA(P< 0.05).The good rate(43.48%)of collateral circulation in LAA group was higher than that(10%)in CE group(P=0.045).The vascular recanalization time and number of thrombectomy in CE group were less than thse in LAA group,but good perfusion ratio of mTICI scores in CE group was higher than that in LAA group. There were no significant differences in NIHSS scores before the operation,NIHSS score and mRS score after 3 months between the two groups(P>0.05).There were also no significant differences in reocclusion after opening, cerebral hemorrhage and death between two groups.Conclusion In comparison with large artery atherosclerosis stroke,mechanical thrombectomy treatment for patients with cardiac embolism stroke needed shorter recanalization time,less number of thrombectomy and got better blood perfusion,but there was similar prognosis in two groups.