经微导管机械碎栓和SolitaireAB型支架取栓治疗急性缺血性脑卒中的比较研究

Comparative study on treatment of acute ischemic stroke between mechanical thrombectomy by micro catheter and embolectomy by SolitaireAB stent

目的比较经微导管机械碎栓和SolitaireAB支架取栓两种方法治疗急性缺血性脑卒中的疗效及安全性。方法回顾性分析2014年1月至2015年12月本院神经内科收治的78例急性脑动脉栓塞患者病历资料,根据治疗方案不同分为A、B两组各39例,A组应用血管内经微导管机械碎栓联合接触性动脉溶栓治疗,B组应用SolitaieAB型支架取栓联合尿激酶溶栓治疗,比较两组患者术后3天、30天脑卒中量表(NIHSS)评分、血管再通率及并发症发生率。结果两组患者术后3天、30天NIHSS评分均较术前显著降低,A组术后3天NIHSS评分显著高于B组(6.0±1.6vs.5.2±1.3)(P<0.05),术后30天两组NIHSS评分差异无统计学意义(3.5±1.8vs.3.3±1.5)(P>0.05);B组术后3天(92.3%vs.79.5%)、30天(97.4%vs.92.3%)血管再通率均高于A组,但差异无统计学意义(P>0.05);两组术后并发症发生率(10.2%vs7.7%)差异亦无统计学意义。结论支架内取栓治疗急性缺血性脑卒中短期疗效略优于经微导管机械碎栓;术后联合尿激酶溶栓,两者恢复期疗效相近。

Objective To compare clinical efficacy between mechanical thrombectomy by micro catheter and embolectomy by SolitaireAB stent in treatment of acute ischemic stroke. Methods Retrospective study was conducted on 78 patients with acute ischemic stroke of January 2014 to December 2015 in neurology Department of our hospital, according to the different schedule, which were divided into A and B group,each with 39 cases,group A underwent endovascular mechanical thrombectomy by micro catheter and contact thrombolysis therapy, and group B underwent embolectomy by SolitaireAB stent and urokinase thrombolysis therapy,3 and 30 days after operation,patients＇ NIHSS score, vascular recanalization ratio and complication incidence of the two groups were compared. Results Two groups of patients with NIHSS scores postoperative 3 ＆30 days decreased significantly compared with preoperation,NIHSS score of group A 3d postoperation was significantly higher than group B （6.0±1.6 vs. 5.2±1.3） （P〈0.05） ,while with no significant difference at 30d postoperation（3.5±1.8 vs. 3.3±1.5）（P〉0.05） ; group B with vascular recanalization ratio postoperative 3 ＆ 30 days were both higher than group A[（92.3% vs. 79.5%） ,（97. 4% vs. 92. 3%）],however both with no significant differences （P〉0.05）; two groups with complication incidences （10.3 % vs7. 7 %） with no statistically significant difference, either. Conclusion Stent embolectomy in treatment of acute ischemic stroke whose short-term efficacy is slightly better than mechanical thrombectomy,and combined with urokinase thrombolyric therapy, efficacies of the two are comparable during recovery period.