机械取栓治疗高龄大脑前循环急性大血管闭塞患者的有效性及安全性

Effectiveness and Safety of Mechanical Thrombectomy in Treating Acute Great Vessel Occlusion of Anterior Cerebral Circulation Patients with Advanced Age

目的分析机械取栓治疗高龄大脑前循环急性大血管闭塞的有效性及安全性。方法选取2016年6月—2018年6月于南阳市中心医院就诊的超出静脉溶栓治疗时间窗并接受机械取栓治疗的大脑前循环急性大血管闭塞患者53例,根据年龄分为高龄组(≥80岁,n=21)和非高龄组(<80岁,n=32)。比较两组患者发病至入院时间、入院至穿刺时间、穿刺至血管再通时间、取栓次数、血管再通率、入院及出院时美国国立卫生研究院卒中量表(NIHSS)评分、90 d预后、症状性颅内出血发生率、90 d病死率。结果 (1)两组患者发病至入院时间、入院至穿刺时间、穿刺至血管再通时间、取栓次数比较,差异无统计学意义(P>0.05)。(2)两组患者血管再通率、入院及出院时NIHSS评分、90 d预后良好者所占比例比较,差异无统计学意义(P>0.05)。(3)两组患者症状性颅内出血发生率、90 d病死率比较,差异无统计学意义(P>0.05)。结论机械取栓治疗高龄大脑前循环急性大血管闭塞患者安全有效,可有效改善患者神经功能及预后,此类患者不应仅因年龄因素而放弃机械取栓治疗。

Objective To analyze the effectiveness and safety of mechanical thrombectomy in treating acute great vessel occlusion of anterior cerebral circulation patients with advanced age.Methods A total of 53 patients with acute great vessel occlusion of anterior cerebral circulation were selected in Nanyang Central Hospital from June 2016 to June 2018,who missed the time-window for intravenous thrombolysis and received mechanical thrombectomy,and they were divided into older group(equal or over 80 years old,n=21)and non-elder group(less than 80 years old,n=32)according to age.Duration between attack and admission,duration between admission and puncture,duration between puncture and vascular recanalization,times of thrombus extraction,vascular recanalization rate,NIHSS score at admission and at discharge,90-day prognosis,incidence of symptomatic intracranial hemorrhage and 90-day fatality rate were compared between the two groups.Results (1)No statistically significant difference of duration between attack and admission,duration between admission and puncture,duration between puncture and vascular recanalization,or times of thrombus extraction was found between the two groups(P>0.05).(2)No statistically significant difference of vascular recanalization rate,NIHSS score at admission or at discharge,or proportion of patients with good 90-day prognosis was found between the two groups(P>0.05).(3)No statistically significant difference of incidence of symptomatic intracranial hemorrhage or 90-day fatality rate was found between the two groups(P>0.05).Conclusion Mechanical thrombectomy is effective and safe in treating acute great vessel occlusion of anterior cerebral circulation patients with advanced age,can effectively improve the neurological function and prognosis,thus mechanical thrombectomy should not be abandoned just because of age in such patients.