急性前循环脑动脉闭塞支架成形术的疗效

Effect of stenting on acute cerebral artery occlusion in anterior circulation

目的探讨支架成形术对急性前循环脑动脉闭塞临床结局的影响。方法回顾性分析2016年1月至2017年6月收治的42例急性前循环脑动脉闭塞的临床资料。急性前循环血管闭塞伴原位狭窄24例,其中取栓术后行支架置入术13例(N1组),单纯取栓术11例(N2组);无原位狭窄18例行单纯取栓术(N3组)。结果 N1、N2、N3组替罗非班使用率分别为69.2%(9/13)、9.1%(1/11)、0%;两两比较均有统计学差异(P<0.05)。N3组手术时间较N1、N2组明显缩短(P<0.05)。N2组术后90 d改良Rankin量表评分0~2分比例明显低于N1、N3组(P<0.05)。3组术后24 h美国国立卫生研究院卒中量表评分、改良脑梗死溶栓治疗分级2b^3级比例、颅内症状性出血发生率、脑疝发生率、病死率均无统计学差异(P>0.05)。结论急性前循环脑动脉闭塞并原位狭窄取栓术后支架置入可能使病人获得更大的收益,抗血小板药物的使用并不增加相关的出血并发症。

Objective To investigate the effect of stenting on the clinical outcome of acute cerebral artery occlusion （ACAO） in theanterior circulation. Methods The clinical data of 42 patients with ACAO in the anterior circulation who were treated by stenting fromJanuary 2016 to June 2017 were retrospectively analyzed. Of 42 patients, 13 patients with orthotopic stenosis were treated with stentimplantation after thrombectomy （N1 group）, 11 with orthotopic stenosis were treated with thrombectomy （N2 group）, and 18 withoutorthotopic stenosis were treated with thrombectomy （N3 group）. Results The use rate of tirofiban of N1 group （69.2% , 9/13） wassignificantly higher than N2 group （9.1%, 1/11; P〈0.05）, which was significantly higher than N3 group （0%; P〈0.05）. The operation timeof N3 group was significantly shorter than N1 and N2 groups （P〈0.05）. The percentage of 90-day modified Rankin scale score of 0 to 2points after operation in N2 group was significantly lower than that in N1 and N3 groups （P〈0.05）. There was no statistical differenceamong the 3 groups in 24-hour National Institutes of Health Stroke Scale score after operation, the percentage of grade 2b-3 of cerebralinfarction thrombolytic therapy, the incidence of intracranial symptomatic hemorrhage, the incidence of cerebral palsy, and the mortalityrate （P〉0.05）. Conclusions The stent implantation after thrombectomy may have benefit for the patients with patients with ACAO in theanterior circulation with orthotopic stenosis. The use of antiplatelet agents does not increase the associated bleeding complications.