急诊血管内支架置入术治疗颈动脉夹层导致急性脑梗死的疗效分析

The analysis of the effect of emergency endovascular stent implantation on acute cerebral infarction caused by cervical artery dissection

目的探讨急诊血管内支架置入术治疗颈动脉夹层导致急性脑梗死的疗效。方法回顾性分析2015年6月-2019年6月于宜昌市中心人民医院就诊的52例颈动脉夹层导致急性脑梗死患者的临床资料;入组患者根据治疗方式分为血管内支架置入组(20例)和药物治疗组(32例);分别记录患者年龄、性别、是否有高血压病、糖尿病等基本情况,比较2组患者颅内出血发生率、脑卒中复发率等情况,并随访其美国国立卫生研究院卒中量表(NIHSS)及改良Rankin量表(mRS)评分及评估血管内支架置入治疗的有效性。结果 2组患者年龄、性别、高血压病、糖尿病、治疗前NIHSS评分比较无明显差异(P>0.05)。血管内支架置入组并发症发生率为30%,高于药物治疗组的18.6%,但2组比较无明显差异(P>0.05)。血管内支架置入组治疗7 d后的NIHSS评分为(2.5±3.2)分,90 d后随访mRS 0~2分患者占80%(16/20);药物治疗组治疗7 d后的NIHSS评分为(5.4±3.5)分,90 d后随访mRS 0~2分患者占50%(16/32),2组比较均有明显差异(P<0.05)。结论急诊血管内支架置入术可改善颈动脉夹层导致的急性脑梗死患者的近期及远期预后。

Objective To explore the effect of emergency endovascular stent implantation on acute cerebral infarction caused by cervical artery dissection. Methods The clinical data of 52 patients with acute cerebral infarction caused by carotid artery dissection treated in Yichang Central People’s Hospital from June 2015 to June 2019 were analyzed retrospectively. According to the treatment methods, the patients were divided into two groups: stenting group(20 cases) and drug treatment group(32 cases). The age, sex, hypertension and diabetes were recorded respectively. The incidence of intracranial hemorrhage and recurrence of stroke were compared between the two groups. The NIHSS score and the modified Rankin Scale(mRS) were followed up to evaluate the effectiveness of endovascular stent implantation. Results There was no significant difference between the two groups in age, gender, hypertension, diabetes and NIHSS score before treatment(P>0.05). The incidence of complications in the stenting group(30%) was higher than that in the drug treatment group(18.6%), but there was no significant difference between the two groups(P>0.05). The NIHSS score was(2.5±3.2) points after 7 days, The proportion of mRS 0~2 score patients was 80%(16/20) after 90 days in the stenting group, the NIHSS score was(5.4±3.5) points after 7 days and The proportion of mRS 0~2 score patients was 50%(16/32) after 90 days in the drug treatment group, the difference was statistically significant between the two groups(P<0.05). Conclusion Emergency endovascular stent implantation could improve the short-term and long-term prognosis of patients with acute cerebral infarction caused by cervical artery dissection.