血管内取栓治疗颈内动脉夹层致串联性闭塞的效果分析

Effect analysis of endovascular thrombectomy in treating tandem occlusion due to internal carotid artery dissection

目的探讨血管内取栓治疗颈内动脉夹层导致的前循环大血管串联性闭塞的安全性和有效性。方法回顾性连续纳入2015年1月至2017年12月全国4家高级卒中中心诊断为颈内动脉夹层合并前循环大血管串联性闭塞的急性缺血性卒中患者86例,其中东部战区总医院32例,南阳市中心医院24例,扬州大学附属医院18例,淮安市第一人民医院12例,诊断均符合颈动脉夹层标准。根据治疗方式的不同,将86例患者分为非血管内取栓组(53例)和血管内取栓组(33例)。非血管内取栓组采用静脉溶栓治疗和(或)药物治疗,血管内取栓组采用Solitaire支架系统进行血管内机械取栓治疗。比较两组年龄、性别、卒中危险因素(高血压病、高脂血症、糖尿病、短暂性脑缺血发作、吸烟史)等基线资料以及入院NIHSS评分、闭塞血管、住院期间药物治疗、静脉溶栓比例、颅内出血和预后等临床资料的差异。将卒中发生90d改良Rankin量表(mRS)评分0~2分定义为临床预后良好。结果(1)两组患者年龄、性别、高血压病、糖尿病、短暂性脑缺血发作、吸烟史、NIHSS评分等基线资料的差异均无统计学意义(均P>0.05)。(2)两组患者血管闭塞部位、静脉溶栓、住院期间药物治疗比例的差异均无统计学意义(均P>0.05)。(3)血管内取栓组患者非症状性颅内出血发生率、预后良好率均高于非血管内取栓组,组间差异有统计学意义[45.5%(15/33)比11.3%(6/53),69.7%(23/33)比45.3%(24/53);均P<0.05];两组症状性颅内出血发生率、病死率差异均无统计学意义(均P>0.05)。结论相较于静脉溶栓治疗和(或)药物治疗,颈内动脉夹层合并急性前循环大血管串联性闭塞的缺血性卒中患者应用血管内取栓治疗安全有效。

Objective To evaluate the safety and efficacy of endovascular thrombectomy in treating anterior circulation large vessel tandem occlusion due to internal carotid artery dissection. Methods From January 2015 to December 2017,86 consecutive acute ischemic stroke patients with anterior circulation large vessel tandem occlusion due to internal carotid artery dissection were retrospectively recruited.Patients were diagnosed at 4 advanced stroke centers in China,including 32 cases at General Hospital of Eastern War Zone,24 cases at Nanyang Central Hospital,18 cases at the Affiliated Hospital of Yangzhou University and 12 cases at the Huai′an First People′s Hospital.The diagnosis was in accordance with the criteria of carotid dissection.Patients were divided into the non-endovascular thrombectomy group (53 patients) and the endovascular thrombectomy group(33 patients) according to treatment methods.The non-endovascular thrombectomy group was treated with intravenous thrombolysis and/or drug therapy,and the endovascular thrombectomy group was treated with mechanical thrombectomy using Solitaire stent system.Baseline and clinical characteristics were compared between the two groups.Baseline characteristics included age,gender,risk factors for stroke (hypertension,hyperlipidemia,diabetes,transient ischemic attack,smoking history), etc.Clinical characteristics included NIHSS score at admission,artery occlusion site,drug therapy during hospitalization,intravenous thrombolysis ratio,intracranial hemorrhage,prognosis,etc.The 90-day modified Rankin Scale (mRS) score of 0 - 2 was defined favorable outcome. Results (1) There were no statistically significant differences in age,gender,hypertension,diabetes,transient ischemic attack,smoking history,NIHSS score at admission and other baseline data between the two groups (all P >0.05).(2)There were no statistically significant differences in artery occlusion site,intravenous thrombolysis ratio and drug therapy during hospitalization between the two groups (all P >0.05).(3) The endovascular thrombectomy group had higher incidence ratio of asymptomatic intracranial hemorrhage(aICH) and higher ratio of favorable outcome(mRS 0 - 2) than the non-endovascular thrombectomy group.The differences were statistically significant between the groups(45.5%[15/33] vs .11.3%[6/53],69.7%[23/33] vs .45.3%[24/53];all P <0.05).There were no statistically significant differences in the incidence rate of symptomatic intracranial hemorrhage and the mortality rate between the two groups (all P >0.05). Conclusion Compared with intravenous thrombolysis and/or drug therapy,endovascular thrombectomy may be a safe and effective method of treating anterior circulation large vessel tandem occlusion due to internal carotid artery dissection.