急性前循环大血管闭塞性脑卒中直接机械取栓与桥接治疗的疗效及安全性的对比研究

Comparative study of efficacy and safety of direct thrombectomy and bridging therapy for acute large-vessel occlusion in anterior circulation stroke

目的比较急性前循环大血管闭塞性脑卒中直接机械取栓与桥接治疗的疗效及安全性。方法回顾性收集自2016年3月至2017年7月在浙江省人民医院神经内科行机械取栓的146例急性前循环大血管闭塞性脑卒中患者的临床资料，其中行直接机械取栓85例、行桥接治疗61例，比较直接机械取栓组和桥接治疗组患者基线资料、诊治情况、并发症和临床预后等的差异。结果直接机械取栓组和桥接治疗组的年龄、性别比例、基线美国国立卫生研究院卒中量表（NIHSS）评分、高血压病比例、糖尿病比例、心房颤动比例、基线血糖水平、血小板计数、肌酐水平、基线收缩压、脑卒中病因、闭塞部位、麻醉方式比较差异均无统计学意义（P〉0.05）；直接机械取栓组和桥接治疗组的到院至影像学检查时间、到院至动脉穿刺时间、动脉穿刺至血管再通时间、到院至血管再通时间比较差异均无统计学意义（P〉0.05）；直接机械取栓组和桥接治疗组的成功再灌注率（91.8% vs. 95.1%）、症状性颅内出血率（11.8% vs. 21.3%）、治疗后90 d预后良好率（41.2% vs. 47.5%）、死亡率（20.0% vs. 18.0%）比较差异均无统计学意义（P〉0.05）。结论对于急性前循环大血管闭塞性脑卒中，直接机械取栓具有与桥接治疗相似的疗效及安全性。

ObjectiveTo compare the efficacy and safety of direct thrombectomy and bridging therapy for acute large-vessel occlusion in anterior circulation stroke.MethodsA retrospective study was performed on clinical data of 146 patients with anterior circulation large-vessel occlusion stroke who accepted direct thrombectomy in our hospital from March 2016 to July 2017; 85 patients were in direct thrombectomy group and 61 patients were in bridging therapy group. The clinical characteristics, procedural complications and clinical outcomes between the two groups were compared.ResultsThere were no significant differences between the two groups in age, gender, baseline National Institutes of Health Stroke Scale （NIHSS） scores, percentages of patients with hypertension, diabetes and atrial fibrillation, baseline blood glucose, platelet count, creatinine level, baseline systolic blood pressure, stroke etiology, occlusion site, and anesthesia methods （P〉0.05）. There were no significant differences between the two groups in admission-to-CT time, admission-to-puncture time, puncture-to-re-canalization time, and admission-to-re-canalization time （P〉0.05）. The successful reperfusion rate （91.8% vs. 95.1%）, incidence of symptomatic intracranial hemorrhage （11.8% vs. 21.3%）, favorable outcome rate 90 d after treatment （41.2% vs. 47.5%）, and mortality （20.0% vs. 18.0%） were not significantly different between the two groups （P〉0.05）.ConclusionThe efficacy and safety of direct thrombectomy and bridging therapy are similar for acute large-vessel occlusion in anterior circulation stroke.