急性大脑中动脉M2段闭塞性缺血性脑卒中血管内治疗的多中心回顾性研究

A multicenter retrospective study of endovascular therapy for acute middle cerebral artery M2 occlusive ischemic stroke

目的探讨血管内治疗对发病至治疗时间≤6 h的急性大脑中动脉M2段闭塞致缺血性脑卒中患者的安全性及有效性.方法回顾性分析2013年9月至2018年7月19家卒中中心收治的103例急性大脑中动脉M2段闭塞性缺血性脑卒中患者的病历资料.依据治疗方法将入选患者分为血管内治疗组(65例)和非血管内治疗组(38例).观察血管内治疗患者治疗后血管再通率、48 h急性再闭塞率及血管穿孔率,同时对比两组患者90 d改良Rankin量表(modified rankin scale,mRS)评分、死亡率、颅内出血、蛛网膜下腔出血及症状性颅内出血发生率.结果血管内治疗组中57例患者血管再通良好,血管再通率为87.7%,48 h内血管急性再闭塞率为7.7%,血管穿孔发生率为1.5%.两组90 d mRS评分≤2分的患者占比比较差异无统计学意义(Z=-1.704,P=0.088).两组患者90 d全因死亡率、症状性颅内出血发生率、蛛网膜下腔出血发生率比较差异均无统计学意义(均P>0.05).结论急性大脑中动脉M2段闭塞性缺血性脑卒中患者行血管内治疗与非血管内治疗的有效性与安全性相似.

Objective To investigate the safety and efficacy of endovascular therapy for acute middle cerebral artery M2 occlusive ischemic stroke within 6 hours of onset. Method Retrospectively analyzed the clinical data of 103 cases of acute ischemic stroke patients with acute middle cerebral artery M2 occlusive ischemic stroke admitted to 19 stroke centers from September 2013 to July2018. They were divided into endovascular therapy group(EVT group, 65 cases) and non-endovascular therapy group(non-EVT group, 38 cases) according to the treatment methods. The vascular recanalization rate, 48 h acute re-occlusion rate and vascular perforation rate of EVT group were observed. Compared the two groups of patients at the 90 days modified rankin scale(m RS) score,mortality rate, incidence of intracranial hemorrhage, subarachnoid hemorrhage and symptomatic intracranial hemorrhage. Result The vascular recanalization was successful in 57 patients of EVT group. The vascular recanalization rate was 87.7%, acute reocclusion rate was 7.7%, and vascular perforation rate was 1.5% in EVT group. There was no significant difference in the proportion of patients with 90 d m RS score≤2 points between the two groups(Z=-1.704, P=0.088). There were no significant differences in the rate of all-cause mortality at 90 d, incidence of symptomatic intracranial hemorrhage and subarachnoid hemorrhage between the two groups(all P>0.05). Conclusion The efficacy and safety of endovascular therapy are similar to that of non-endovascular therapy in patients with acute middle cerebral artery M2 occlusive ischemic stroke.