不同大血管闭塞性急性缺血性卒中患者静脉溶栓疗效比较

Comparison of Intravenous Thrombolytic Effect of Acute Ischemic Stroke Patients with Different Large Vessel Occlusion

目的对不同大血管闭塞所致的急性缺血性卒中患者静脉溶栓疗效进行比较分析,探讨适宜静脉溶栓治疗的大血管闭塞患者。方法本研究的入选患者来自中国急性缺血性卒中溶栓监测登记研究,从中选取所有完成了溶栓前多模式计算机断层扫描(computed tomography,CT)或磁共振成像(magnetic resonance imaging,MRI),且血管成像提示有责任大血管闭塞的患者,对不同大血管闭塞的急性缺血性卒中患者静脉溶栓的有效性及安全性结局进行比较分析。结果共入选122例患者,大脑中动脉闭塞组溶栓后血管再通率为55.2%,而颈内动脉闭塞组为0%,基底动脉闭塞组为40%。大脑中动脉闭塞组90 d随访生活自理[53.9%vs 21.1%,P=0.007,比值比(odds ratio,OR)=5.68]及良好预后(42.7%vs 21.1%,P=0.041,OR=3.76)的比例均优于颈内动脉闭塞组,死亡率低于颈内动脉闭塞组(4.5%vs 47.4%,P<0.001,OR=0.03),而两组溶栓后的症状性颅内出血发生率差异无显著性(1.1%vs 0%,P=0.962)。结论不同大血管闭塞性急性缺血性卒中患者静脉溶栓效果有明显差异,大脑中动脉闭塞患者静脉溶栓开通率最高,疗效明显优于颈内动脉闭塞患者。

Objective To compare the intravenous thrombolytic therapeutic effect of the acute ischemic stroke patients with different large vessel occlusion and to investigate which occlusion subtype of patients are suitable for intravenous thrombolytic treatment. Methods Data were analyzed from the Thrombolysis Implementation and Monitoring of Acute Ischemic Stroke in China （TIMS-China）. Patients who accomplished multiple parameter computed tomography （CT） or magnetic resonance （MR） and CT angiography or MR angiography showed large vessel occlusion were included. The safety and efifcacy outcome were compared. Results A total of 122 patients were included. The rates of recanalization were：middle cerebral artery （MCA） occlusion group 55.2%, internal carotid artery （ICA） occlusion group 0%and basilar artery （BA） occlusion group 40%. For the functional independence outcome at 90 days, MCA occlusion group was significantly better than ICA occlusion group （53.9%vs 21.1%, P=0.007, [odds ratio, OR]=5.68）. For excellent recovery outcome at 90 days, MCA occlusion group was also signiifcantly better than ICA occlusion group （42.7%vs 21.1%, P=0.041, OR=3.76）. For mortality, MCA group was signiifcantly lower than ICA group （4.5%vs 47.4%, P＆lt;0.001, OR=0.03）. There were no signiifcant differences between MCA group and ICA group in the symptomatic intracranial hemorrhage （1.1%vs 0%, P=0.962）. Conclusion The intravenous thrombolytic therapeutic effect of the acute ischemic stroke patients with different large vessel occlusion was signiifcantly different. The recanalization rate of MCA occlusion group was highest, and the therapeutic effect was signiifcantly better than ICA occlusion group.