机械取栓和静脉溶栓治疗急性椎基底动脉闭塞性脑梗死的效果比较

A comparative study of mechanical thrombectomy and intravenous thrombolysis in acute vertebrobasilar occlusive cerebral infarction

目的比较急性椎基底动脉闭塞性脑梗死患者行机械取栓和静脉溶栓的治疗效果差异。方法前瞻性纳入自2014年2月至2019年12月湖州市第一人民医院(湖州师范学院附属第一医院)卒中中心收治的111例急性椎基底动脉闭塞性脑梗死患者,依据家属意愿将患者分为机械取栓组(66例)和静脉溶栓组(45例)。机械取栓组患者采取越过静脉溶栓直接进行机械取栓治疗;静脉溶栓组患者先采用静脉溶栓,对无效者如条件许可、家属愿意再采取机械取栓(桥接治疗)。治疗后评估2组患者的血管再通率、症状性颅内出血发生率、美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分及死亡率。结果研究过程中中途退出7例(机械取栓组4例、静脉溶栓组3例),最后纳入统计分析104例(机械取栓组62例、静脉溶栓组42例)。机械取栓组有54例(87.1%)血管成功再通,血管再通率较静脉溶栓组[26例(61.9%)]高,差异有统计学意义(P<0.05)。机械取栓组有8例(12.9%)发生症状性颅内出血,静脉溶栓组6例(14.3%),差异无统计学意义(P>0.05)。机械取栓组治疗有效(治疗前后NIHSS评分的差值彡4分或治疗后NIHSS评分为0分)率为67.7%,高于静脉溶栓组(38.1%);预后良好率(58.1%)优于静脉溶栓组(28.6%),死亡率(3.2%)低于静脉溶栓组(14.3%),差异均有统计学意义(P<0.05)。16例静脉溶栓未通患者中14例改行取栓桥接治疗(2例患者家属拒绝再取栓),其血管再通率(78.6%)、颅内出血率(14.3%)、治疗有效率(50.0%)、预后良好率(57.1%)、死亡率(7.1%)与机械取栓组相比差异均无统计学意义(P>0.05)。结论对于急性椎基底动脉闭塞性脑梗死患者,机械、取栓能有效提高血管再通率,改善临床预后,即使是静脉溶栓无效后的再取栓(桥接治疗)也同样安全有效。

Objective To compare the therapeutic efficacies of mechanical thrombectomy(MT)and intravenous thrombolysis(IT)in patients with acute vertebrobasilar occlusive cerebral infarction.Methods A prospective inclusion of 111 patients with acute vertebrobasilar artery occlusion admitted to our hospital from February 2014 to December 2019 was performed;these patients were divided into MT group(n=66)and IT group(n=45)according to the wishes of their families.MT was performed directly in patients from the MT group;IT was performed jBrstly in those from the IT group,and MT(also known as bridging treatment)was then used for those who showed no efficacy in IT when condition permission and having family member's willing.Vascular recanalization rate,incidence of symptomatic intracranial hemorrhage,National Institutes of Health Stroke Scale(NIHSS)scores,modified Rankin Scale(mRS)scores and mortality rate were assessed in the two groups after treatment.Results During the course of the study,7 patients(4 in the MT group and 3 in the IT group)dropped out,and finally 104(62 in the MT group and 42 in the IT group)were included in the statistical analysis.Fifty-four patients in MT group had succeeded recanalization,and the recanalization rate(87.1%)was statistically higher than that in IT group(61.9%,P<0.05).There were 8 patients(12.9%)with symptomatic intracranial hemorrhage in MT group and 6 patients(14.3%)in IT group,without significant difference(P>0.05).The treatment effective rate(difference value of NIHSS scores before and after treatment≥4 or NIHSS score after treatment=0)in patients from MT group(67.7%)was significantly higher than that in IT group(38.1%),the good prognosis rate(58.1%)was statistically higher than that in IT group(28.6%),and the mortality rate(3.2%)was statistically lower than that in IT group(14.3%,P<0.05).Among the 16 patients who did not receive IT,14 patients changed to accept bridging treatment(2 family members refused re-thrombectomy);the vascular recanalization rate(78.6%),intracranial hemorrhage rate(14.3%),treatment effective rate(50.0%),good prognosis rate(57.1%),and mortality rate(7.1%)showed no significant differences as compared with those in the MT group(P>0.05).Conclusion For patients with acute vertebrobasilar occlusive cerebral infarction,MT can improve the vascular recanalization rate and clinical prognosis;even after the failure of IT,re-thrombectomy(bridging treatment)is still safe and effective.