Solitaire支架取栓与静脉溶栓对老年人急性椎基底动脉闭塞性卒中的疗效

Comparation of the effect of Solitaire stent thrombectomy versus intravenous thrombolysis on stroke due to acute vertebrobasilar occlusion in the elderly

目的比较Solitaire支架取栓与静脉溶栓治疗对老年人急性椎基底动脉闭塞性卒中的疗效及安全性。方法回顾性分析在我院神经内科住院的患者76例,根据血管开通方式及家属意愿分为Solitaire支架取栓组(30例)和静脉溶栓组(46例)两组,比较两组患者的血管再通率、24 h美国国立卫生院卒中量表(NIHSS)评分改善率、90 d后改良Rankin量表(mRS)评分改善情况、症状性颅内出血发生率及90 d病死率。结果Solitaire支架取栓组患者血管再通率〔86.7%(26/30)〕、24 h NIHSS评分改善率〔66.7%(20/30)〕、90 d后mRS评分改善情况〔53.3%(16/30)〕,明显高于静脉溶栓组〔45.7%(21/46)〕、〔34.8%(16/46)〕、〔23.9%(11/46)〕(χ^2=6.543、3.900、3.761,P=0.012、0.041、0.046)。Solitaire支架取栓组患者症状性颅内出血发生率〔6.7%(2/30)〕与静脉溶栓组〔19.6%(9/46)〕比较,差异无统计学意义(χ^2=0.813,P=0.357),但其90 d死亡发生率〔0.0%(0/30)〕低于静脉溶栓组〔30.4%(14/46)〕,(Fisher精确概率P=0.017)。结论对老年急性椎基底动脉闭塞性卒中患者采用Solitaire支架取栓较静脉溶栓疗效好,安全性高。

Objective To compare the efficacy and safety of solitaire stent thrombectomy versus intravenous thrombolysis for treatment of elderly stroke patients with acute vertebrobasilar occlusion. Methods Clinical data of 76 patients with acute vertebrobasilar occlusion at the neurology department of Anyang People's Hospital from May 2014 to July 2017 were retrospectively analyzed.Patients were divided into two groups: solitaire stent thrombectomy group(n=30)and intravenous thrombolysis group(n=46). Recanalization rates, score improvement rate in National Institutes of Health Stroke Scale(NHISS)after 24 hours of treatment, symptomatic intracranial hemorrhage rate and mortality at 90 days after treatment were compared between the two groups. Results The recanalization rate, NIHSS score improvement rate at 24 hours after treatment and the improvement rate of Modified Rankin Scale(mRS)score at 90 days after treatment were significantly higher in the solitaire stent thrombectomy group than in the intravenous thrombolysis group〔86.7%(26/30)vs.45.7%(21/46), 66.7%(20/30)vs.34.8%(16/46), 53.3%(16/30)vs.23.9%(11/46),χ^2=6.543, 3.900 and 3.761, P=0.012, 0.041 and 0.046, respectively〕. No significant difference in incidence of intracranial hemorrhage was found between the two groups〔6.7%(2/30)vs.19.6%(9/46),χ^2=0.813, P=0.357〕. The mortality at 90 days after treatment were significantly lower in the solitaire stent thrombectomy group than in the intravenous thrombolysis group〔0.0%(0/30)vs.30.4%(14/46), P=0.017〕. Conclusions Solitaire stent thrombectomy versus intravenous thrombolysis has better efficacy and higher safety in treating acute stroke due to vertebrobasilar occlusion in elderly patients.