急性大血管闭塞性卒中单纯取栓和桥接治疗的疗效观察

Efficacy of Simple Thrombectomy and Bridging in treatment of Acute Large Arterial Occlusive Stroke

目的:探讨急性大血管闭塞性卒中单纯机械取栓与静脉溶栓桥接动脉内取栓的疗效对比。方法:收集2014年8月至2018年5月80例前循环大动脉闭塞卒中患者,按治疗方法不同分为桥接治疗组和单纯机械取栓组,比较两组患者治疗前、治疗后24h、治疗后2周的NIHSS评分、治疗后3个月的mRS评分、aICH发生率、s ICH发生率,死亡率。结果:组内比较,对比治疗前,两组患者的NIHSS评分均明显改善(P<0.01):组间比较,两组患者经治疗24h及治疗后2周的NIHSS评分无统计学差异(P>0.05);两组患者的aICH、s ICH的发生率无统计学差异(P>0.05);治疗后3个月的死亡率、生存者mRS评分(0～1)及mRS评分(0～2)区间人数无统计学差异(P>0.05);桥接组与单纯组入院至影像检查时间无统计学差异(P>0.05);单纯组较桥接组在入院至治疗及发病至再通时间方面均明显少于桥接组,存在显著差异(P<0.01)。结论:在急性大血管闭塞卒中治疗中,桥接治疗与单纯机械取栓均具有较好的血管再通疗效,桥接治疗对比单纯机械取栓在预后、死亡率、颅内出血并发症发生率、生存质量上无明显差异,单纯机械取栓相比较具有较短的血管内治疗启动时间,能在更短的时间窗内完成血管内治疗,但仍需要进一步的随即临床试验比较二者的收益与风险。

Objective:To compare the efficacy of simple mechanical thrombectomy and intravenous thrombolysis in the treatment of acute macrovascular occlusive stroke.Methods:80 patients with anterior circulation aortic occlusion stroke were admitted to our hospital from August 2014 to May 2018.They were divided into a bridging treatment group and a simple mechanical thrombectomy group according to different treatment methods.The two groups were compared before treatment and 24 hours after treatment.NIHSS score at 2 weeks after treatment,mRS score at 3 months after treatment,incidence of aICH,incidence of sICH,and mortality.Results:In the group,the NIHSS scores of the two groups were significantly improved before the treatment(P<0.01).There was no significant difference in the NIHSS score between the two groups after 24 hours of treatment and 2 weeks after treatment.>0.05);There was no significant difference in the incidence of aICH and sICH between the two groups(P>0.05);mortality after 3 months of treatment,survivor mRS score(0~1)and mRS score(0~2)There was no significant difference in the number of patients between the two groups(P>0.05).There was no significant difference between the bridging group and the simple group(P>0.05).The simple group was significantly different from the bridging group in terms of admission to treatment and onset to recanalization time.There was a significant difference(P<0.01)compared to the bridge group.Conclusion:In the treatment of acute large vessel occlusion stroke,bridging therapy and mechanical thrombectomy alone have better effect of revascularization.There was no significant difference in prognosis,mortality,incidence of complications and quality of life between bridging therapy and mechanical thrombectomy alone.Compared with mechanical thrombectomy alone,it has a shorter start-up time and can complete endovascular therapy in a shorter time window.However,further clinical trials are needed to compare the benefits and risks of both methods.