机械取栓治疗心源性和非心源性急性脑卒中有效性和安全性对比分析

Effectiveness and safety of mechanical thrombectomy for the treatment of stroke: comparative study between acute cardioembolic stroke and acute non-cardioembolic stroke

目的对比分析血管内机械取栓治疗心源性(CE)和非心源性(NCE)急性脑卒中的临床效果和安全性。方法回顾性分析2017年3月至2018年5月采用血管内机械取栓治疗的28例急性前循环缺血性脑卒中患者临床资料。根据TOAST研究组病因分型分为CE组(n=10例)和NCE组(n=18),比较两组患者血管再通率、补救性支架植入率、不良事件发生率、90d内病死率、术前和术后7d美国国立卫生研究院卒中量表(NIHSS)评分、术后90d改良Rankin量表(mRS)评分(mRS≤2分为预后良好)。结果CE组10例(100%)、NCE组17例(94.4%)患者达到血管良好再通[脑梗死溶栓(TICI)治疗后血流分级2b^3级],差异无统计学意义(P>0.05)。CE组术前、术后7dNIHSS评分分别为15.88±3.40、7.75±4.03,NCE组分别为12.57±4.05、7.50±5.87,两组术后7dNIHSS评分均较术前降低,差异有统计学意义(P<0.05)。CE组、NCE组分别植入0枚(0%)、6枚(33.3%)支架,差异有统计学意义(P<0.05)。CE组发生脑出血3例,NCE组发生脑出血2例,消化道出血1例,急性心力衰竭1例,两组不良事件发生率分别为30%、22.2%,差异无统计学意义(P>0.05)。CE组、NCE组术后90d预后良好率分别为60%(6/10)、50%(9/18),差异无统计学意义(P>0.05);90d内病死率分别为20%(2/10)和22.2%(4/18),差异无统计学意义(P>0.05)。结论血管内机械性取栓治疗CE急性前循环缺血性脑卒中患者不增加术后不良事件和死亡发生率,可达到与NCE患者相似的临床效果。

Objective To compare the clinical efficacy and safety of intravascular mechanical thrombectomy for acute cardioembolic(CE) stroke with those for acute non-cardioembolic(NCE) stroke.Methods The clinical data of 28 patients with acute anterior circulation ischemic stroke,who underwent mechanical thrombectomy during the period from March 2017 to May 2018,were retrospectively analyzed.According to TOAST classification,the patients were divided into CE group(n=10) and NCE group(n=18).The vascular recanalization rate,the rate of rescue stent implantation,the incidence of adverse events and the mortality rate within 90 days,preoperative and 7- day postoperative National Institutes of Health Stroke Scale (NIHSS) score, 90- day postoperative modified Rankin scale(mRS) score(mRS≤2 points being regarded as a good prognosis) were calculated,and the results were compared between the two groups.Results Ten patients (100%) in CE group and 17 patients(94.4%) in NCE group achieved good revascularization(TICI grade 2b- 3),and the difference between the two groups was not statistically significant(P>0.05).The preoperative and 7-day postoperative NIHSS scores in CE group were (15.88±3.40) and (7.75±4.03) respectively,which were (12.57±4.05) and (7.50±5.87) respectively in NCE group.The 7-day postoperative NIHSS score was lower than the preoperative one in both groups,and the difference was statistically significant(P<0.05).In CE group and NCE group 0 stent(0%) and 6 stents(33.3%) were respectively implanted,and the difference between the two groups was statistically significant(P<0.05).In CE group cerebral hemorrhage occurred in 3 patients,and in NCE group cerebral hemorrhage occurred in 2 patients,digestive tract hemorrhage in one patient,and acute heart failure in one patient.The incidences of adverse events in CE group and NCE group were 30% and 22.2% respectively,and the difference between the two groups was not statistically significant(P>0.05).The 90-day postoperative good prognosis rates in CE group and NCE group were 60%(6/10) and 50%(9/18) respectively, and the difference between the two groups was not statistically significant(P>0.05).The mortality rates within 90 days in CE group and NCE group were 20%(2/10) and 22.2%(4/18) respectively,and the difference between the two groups was not statistically significant (P>0.05).Conclusion In treating patients with cardioembolic acute anterior circulation ischemic stroke,mechanical intravascular thrombectomy does not increase the incidence of adverse events and death,and it can achieve the similar clinical effect as in treating patients with NCE stroke.