Solitaire支架动脉取栓术治疗急性心源性脑栓塞疗效观察

Efficacy of Solitaire^TM stent arterial embolectomy in Wearing acute cardiogenic cerebral embolism

目的探讨Solitaire支架动脉取栓术治疗急性心源性脑栓塞的有效性及安全性。方法收集自2012年10月至2016年3月解放军第一八〇医院神经内科采用Solitaire支架动脉取栓术或联合rt—PA静脉溶栓治疗的急性心源性脑栓塞（CCE）患者共24例，并选取同期收治的单纯进行rt-PA静脉溶栓的CCE患者作为对照组（共21例）。对比2组患者近期疗效、远期临床预后及并发症发生率、死亡率等情况，同时进一步对比2组中后循环梗死患者临床预后。结果研究组患者发病至rt—PA用药中位时间为3．17h，低于对照组的4．00h，差异有统计学意SL（P〈0．05）。研究组使用rt-PA剂量与对照组均为50mg，差异无统计学意义（P〉0．05）。研究组出院时NIHSS评分、GCS评分改善情况及3个月、6个月后mRS评分均显著优于对照组，差异有统计学意义（P〈0．05）。而2组患者症状性颅内出血、高灌注脑病、脑疝的发生率、死亡率差异无统计学意义（P〉0．05）。研究组后循环梗死患者3月后mRS评分为2．00分，显著低于对照组的3．00分，差异有统计学意义（P〈0．05）。结论Solitaire支架动脉取栓术治疗与单纯静脉溶栓治疗比较可以显著改善急性CCE患者近期神经功能及远期临床预后，且不增加患者并发症的发生率及死亡率，安全有效：后循环梗死患者亦可以从动脉取栓术中获益。

Objective To explore the efficacy and safety of Solitaire stent arterial embolectomy in the treatment of acute cardiogenic cerebral embolism. Methods The data of 24 patients who underwent Solitaire stent arterial embolectomy, either alone or in combination with reorganization type tissue plasminogen activator （rt-PA） intravenous thrombolysis, to treat acute cardiogenic cerebral embolism in our hospital were collected. These results between October 2012 and March 2016 were compared with 21 control patients who were treated using only rtPA 1V thrombolysis. The short-term efficacy, long-term clinical outcomes, complications, and mortality rate of these two groups were compared, and the clinical outcomes of these patients with posterior circulation infarction in the two groups were furtber assessed. Results The time between onset and rt-PA administration in the study group （median time： 3.17 h） was significantly shorter than that in the control group （4.00 h, P〈0.05）; rt-PA dose used in both two groups was 50 mg. NIHSS scores and Glasgow Coma scale scores at discharge, and modified Rankin scale （mRs） scores 3 and 6 months after treatment in the study group were significantly higher than those in the control group （P〈0.05）. There were no significant differences in symptomatic intra-cerebral hemorrhage, high perfusion encephalopathy, incidence of hernia, or mortality between the two groups （P〉0.05）. The mRS scores 3 months after treatment in patients with posterior circulation infarction （2） were significantly lower than those in the control group （3, P〈0.05）. Conclusions As compared with simple venous thrombolytic therapy, Solitaire stent embolectomy can significantly improve short-term neurological function and long-term prognosis in patients with acute cardiogenic cerebral embolism, enhance their life quality, without increasing the complication incidence and mortality rate. It is safe and effective, and patients with posterior circulation infarction can also be treated by arterial embolectomy.