静脉溶栓或桥接治疗对大动脉闭塞急性轻型缺血性脑卒中患者的疗效和安全性

Efficacy and safety of intravenous thrombolysis or bridging therapy for acute minor ischemic stroke with large artery occlusion

目的探讨单纯静脉溶栓或桥接治疗大动脉闭塞急性轻型缺血性脑卒中(MIS)的有效性和安全性。方法连续纳入2013年9月至2018年6月由脑卒中绿色通道收入我院的静脉溶栓时间窗(≤4.5 h)内的急性大动脉闭塞MIS患者73例,其中静脉溶栓组55例、桥接治疗组18例。静脉溶栓组患者使用重组组织型纤溶酶原激活剂(rt-PA)进行静脉溶栓治疗,桥接治疗组为患者在静脉溶栓后在取栓时间窗内完成血管再通治疗。所有患者均在入院时行美国国立卫生研究院卒中量表(NIHSS)评分,治疗后90 d行改良Rankin量表(m RS)评分(0~2分为预后良好,3~6分为预后不良)。结果两组患者入院时年龄、性别、既往病史、吸烟史、无症状梗死灶患者比例、术前NIHSS评分、格拉斯哥昏迷量表评分、Alberta脑卒中早期计算机断层扫描评分以及入院至静脉溶栓时间、发病至静脉溶栓时间差异均无统计学意义(P均>0.05)。两组患者治疗后7 d、90 d预后良好率、症状性颅内出血发生率、死亡率差异均无统计学意义(P均>0.05),但静脉溶栓组患者全身并发症的发生率低于桥接治疗组,差异有统计学意义[23.6%(13/55)vs 44.4%(8/18);X^2=2.434,P=0.019]。结论单纯静脉溶栓与桥接治疗大动脉闭塞急性MIS的临床疗效和安全性相似;尽管桥接治疗患者的全身并发症发生率高于单纯行静脉溶栓治疗患者,但二者远期疗效均较好。

Objective To explore the efficacy and safety of intravenous thrombolysis or bridging therapy for acute minor ischemic stroke(MIS)with large artery occlusion.Methods Seventy-three acute MIS patients with large artery occlusion,who admitted to our hospital via stroke green channel within 4.5 h after onset from Sep.2013 to Jun.2018,were enrolled in this study,including 55 cases in intravenous thrombolysis group and 18 cases in bridging therapy group.The patients in the intravenous thrombolysis group underwent intravenous thrombolysis treatment with recombinant tissue plasminogen activator(rt-PA),and the patients in the bridging therapy group underwent thrombectomy within time window after intravenous thrombolysis.National Institutes of Health stroke scale(NIHSS)score at admission and modified Rankin scale(mRS)score at 90 days after treatment were evaluated in all patients.The mRS scoring 0-2 was good prognosis,and 3-6 was poor prognosis.Results There were no significant differences in the gender,age,medical history,smoking history,ratio of asymptomatic cerebral infarction,NIHSS score at admission,Glasgow coma scale score,Alberta stroke program early conputed tomography score,door-to-needle time or onset-to-needle time between the two groups(all P>0.05).The rates of good prognosis at 7 d and 90 d after treatment,incidence of symptomatic intracranial hemorrhage and mortality were not significantly different between the two groups(all P>0.05),while the incidence of systemic complications was significantly lower in the intravenous thrombolysis group than that in the bridging therapy group(23.6%[13/55]vs 44.4%[8/18];χ2=2.434,P=0.019).Conclusion Intravenous thrombolysis and bridging therapy have similar clinical efficacy and safety in treatment of acute MIS with large artery occlusion;although the incidence of systemic complications in patients with bridging therapy is higher than that in patients treated with intravenous thrombolysis,the long-term effects are both good.