Solitaire AB支架取栓、静脉溶栓治疗心源性脑栓塞的对比研究

Comparative study of Solitaire AB thrombectomy and intravenous thrombolysis in cardiogenic cerebral embolism

目的比较SolitaireAB支架取栓和静脉溶栓治疗心源性脑栓塞的疗效及安全性。方法回顾性分析佛山市顺德区第一人民医院神经内科自2012年1月至2015年5月收治的41例心源性脑栓塞患者临床资料，依据治疗方法不同分为支架取栓组（15例）和静脉溶栓组（26例）。支架取栓组患者给予Solitaire支架取栓治疗m静脉溶栓组患者静脉给予重组组织型纤溶酶原激活物（rt-PA）或尿激酶溶栓治疗。对比2组患者的血管再通率[以脑梗死溶栓等级系统（TICI）≥2B级为再通）、24h美国国立卫生院卒中量表（NIHSS）评分改善率（较治疗前减少≥4分或症状完全消失）、90d后改良Rankin量表（mRS）评分改善情况（≤2分定义为神经功能良好）、脑出血情况（参照ECASSⅡ标准）及90d死亡率。结果支架取栓组13例（86．67％）患者血管再通，10例（66．67％）患者24h NIHSS评分改善，8例（53．33％）患者90d后mRS评分良好；静脉溶栓组12例（46．15％）患者血管再通，9例（34．62％）患者24h NIHSS评分改善，6例（23．08％）患者90d后mRS评分良好；3项指标差异均有统计学意义（P〈0．05）。支架取栓组1例（6．67％）患者发生症状性脑出血，90d内无患者死亡；静脉溶栓组11例（42．31％）患者发生症状性脑出血；90d内8例（30．77％）患者死亡；2项指标差异均有统计学意义（P〈0．05）。结论对心源性脑栓塞的治疗中，Solitaire AB支架取栓较静脉溶栓疗效更好，安全性更高。

Objective To compare the efficacy and safety between Solitaire AB thrombectomy and intravenous thrombolysis in cardiogenic cerebral embolism. Methods Retrospective analysis of clinical data of 41 patients with cardiogenic cerebral embolism, admitted to our hospital from January 2012 to May 2015, was performed. According to different treatments, these patients were divided into Solitaire AB thrombectomy group （n=15） and intravenous thrombolysis group （n=26）; patients in the Solitaire AB thrombectomy group were performed Solitaire AB thrombectomy, and patients in the intravenous thrombolysis group were given recombinant tissue plasminogen activator （rt-PA） or urokinase to achieve thrombolysis. Clinical outcomes were compared between two groups such as recanalization rates （thrombolysis in cerebral infarction [TICI] ≥2B）, changes of NIHSS scores after 24 hours （scores decreased equal to or at least 4 points or complete resolution of symptoms）, cerebral hemorrhage rate （European Cooperative Acute Stroke Study II standard）, modified Rankin scale （mRS） score improvement and mortality 90 days after treatment. Results In patients from Solitaire AB thrombectomy group, the recanalization rate was 86.67% （13/15）, 10 patients （66.67%） got good outcomes in NIHSS scores, one patient （6.67%） occurred symptomatic cerebral hemorrhage; 90 days after treatment, the rate of good prognosis （mRS 0-2） was 53.33% （8/15） and no patients died. In patients from intravenous thrombolysis group, the recanalization rate was 46.15% （12/26）, 9 patients （34.62%） got good outcomes in NIHSS scores, 11 patients （42.31%） occurred symptomatic cerebral hemorrhage; 90 days after treatment, the rate of good prognosis （mRS 0-2） was 23.08% （6/26） and 8 patients （30.77%） died. The above data comparisons between two groups were statistically significant （P〈0.05）. Conclusion As compared with intravenous thrombolysis, Solitaire AB thrombectomy has better efficacy and safety in the treatment of cardiogenic cerebral embolism.