不同卒中分型急性基底动脉闭塞机械取栓临床研究

Clinical efficacy and safety of mechanical thrombectomy for acute basilar artery occlusion in different types of stroke

目的比较不同卒中分型急性基底动脉闭塞(BAO)患者机械取栓的临床疗效和安全性。方法回顾性纳入2017年4月至2019年4月在苏州大学附属第一医院总院接受机械取栓治疗的29例急性BAO患者。采用中间导管联合Solitaire FR支架行机械取栓,评价急性BAO机械取栓可行性、血管再通率、90 d预后良好率和手术相关并发症。结果29例急性BAO患者中TOAST分型为心源性脑栓塞(CE)型19例(CE组),大动脉粥样硬化性脑卒中(LAA)型9例(LAA组),病因不明栓塞1例。26例(89.7%)闭塞血管成功再通(mTICI分级2b/3级),其中CE组、LAA组分别为17例(89.5%)、8例(88.9%)(P>0.05),病因不明1例。CE组、LAA组患者发病至医院就诊时间分别为(203.6±99.2)min、(353.8±210.8)min(P<0.05),分别有2例、3例接受补救性支架植入(P>0.05),取栓次数分别为(1.6±0.9)次、(2.0±1.4)次(P>0.05)。术后90 d预后良好率(改良Rankin量表评分≤2分)为48.3%(14/29),其中CE组、LAA组分别为52.6%(10/19)、33.3%(3/9)(P>0.05),病因不明1例恢复良好。手术相关并发症包括异位栓塞、出血转化。结论机械取栓治疗急性BAO安全可行。CE患者和LAA患者90 d预后良好率无差异,但CE患者发病至医院就诊时间较短于LAA患者。

Objective To compare the clinical efficacy and safety of mechanical thrombectomy in treating patients with acute basilar artery occlusion(BAO)of different types of stroke.Methods A total of 29 patients with acute BAO,who were admitted to the First Affiliated Hospital of Soochow University of China during the period from April 2017 to April 2019 to receive mechanical thrombectomy,were enrolled in this study.Intermediate catheter together with Solitaire FR stent was used to conducted mechanical thrombectomy.The feasibility of mechanical thrombectomy for acute BAO,the recanalization rate of occluded artery,the rate of postoperative 90-day good prognosis,and the procedure-related complications were evaluated.Results Among the 29 patients with BAO,cardioembolism(CE)type of TOAST classification was seen in 19 patients(CE group),large-artery atherosclerotic stroke(LAA)in 9 patients(LAA group),and undetermined etiology in one patient.Successful recanalization of occluded artery was obtained in 26 patients(89.7%),with 2b/3 level of modified Thrombolysis in Cerebral Infarction(mTICI)classification.Among the 26 patients,CE group had 17 patients(89.5%)and LAA group had 8 patients(88.9%)(P>0.05),and the remaining one was the patient with unknown etiology.In CE group and LAA group,the mean time interval from the onset of disease to hospital visit was(203.6±99.2)min and(353.8±210.8)min respectively(P<0.05),the implantation of remedial stent was carried out in 2 patients and 3 patients respectively(P>0.05),and the mean number of mechanical thrombectomy procedures was(1.6±0.9)times and(2.0±1.4)times respectively(P>0.05).The total good rate of postoperative 90-day prognosis(modified Rankin scale score≥2 points)was 48.3%(14/29),and the good rates of postoperative 90-day prognosis in CE group and LAA group were 52.6%(10/19)and 33.3%(3/9)respectively(P>0.05).The procedure-related complications included ectopic embolization and hemorrhagic transformation.Conclusion For the treatment of acute BAO,mechanical thrombectomy is safe and feasible.There is no statistically significant difference in good rate of postoperative 90-day prognosis between CE patients and LAA patients,although the mean time interval from the onset of disease to hospital visit of CE patients is shorter than that of LAA patients.