血管内机械血栓切除术治疗急性大脑中动脉M2段闭塞

Endovascular mechanical thrombectomy for acute middle cerebral artery M2 segment occlusion

目的探讨血管内机械血栓切除术(endovascular mechanical thrombectomy,EMT)治疗急性大脑中动脉(middle cerebral artery,MCA)M2段闭塞的有效性和安全性。方法回顾性分析2017年5月至2019年11月在中山市人民医院脑血管介入科接受治疗的急性MCA M2段闭塞患者的病历资料,按照临床决策分为EMT组和非EMT组,对影像学和临床资料进行分析。血管成功再通定义为改良脑梗死溶栓血流分级(modified Thrombolysis in Cerebral Infarction,mTICI)≥2b级,转归良好定义为发病后90 d时改良Rankin量表评分≤2分。采用多变量logistic回归分析确定转归的独立影响因素。结果共纳入32例患者,男性18例(56.3%);年龄(63.87±8.64)岁,基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分(13.91±3.45)分。EMT组20例(62.5%),非EMT组12例(37.5%);16例(50.0%)转归良好,16例(50.0%)转归不良。EMT组血管成功再通率为85.0%,90 d转归良好率显著高于非取栓组(65.0%对25.0%;χ^2=4.800,P=0.029),而有症状颅内出血发生率(10.0%对0%;P=0.516)和病死率(10.0%对8.3%;P=1.000)均差异无统计学意义。转归良好组与转归不良组基线NIHSS评分以及吸烟和接受EMT治疗的患者构成比差异有统计学意义。多变量logistic回归分析显示,高基线NIHSS评分与转归不良独立相关[优势比(odds ratio,OR)2.392,95%可信区间(confidence interval,CI)1.190~4.810;P=0.014],而EMT则与转归良好独立相关(OR 0.038,95%CI 0.002~0.913;P=0.044)。结论EMT治疗急性MCA M2段闭塞是安全有效的,可显著改善患者临床转归。

Objective To evaluate the effectiveness and safety of endovascular mechanical thrombectomy(EMT)in the treatment of acute middle cerebral artery(MCA)M2 segment occlusion.Methods The medical records of patients with acute MCA M2 segment occlusion treated in the Department of Cerebrovascular Interventional Radiology,Zhongshan People's Hospital from May 2017 to November 2019 were analyzed retrospectively.The patients were divided into EMT group and non-EMT group according to the clinical decision,and their imaging and clinical data were analyzed.Successful recanalization was defined as the modified Thrombolysis In Cerebral Infarction(mTICI)grade≥2b,and good outcome was defined as the modified Rankin Scale score≤2 at 90 d after onset.Multivariate logistic regression analysis was used to identify the independent influencing factor of outcome.Results A total of 32 patients were enrolled,18(56.3%)were male.Their age was 63.87±8.64 years,baseline National Institutes of Health Stroke Scale(NIHSS)score was 13.91±3.45.There were 20(62.5%)in the EMT group and 12(37.5%)in the non-EMT group,16(50.0%)had good outcomes and 16(50.0%)had poor outcomes.The successful recanalization rate in the EMT group was 85.0%,and the 90 d good outcome rate was significantly higher than that of the non-EMT group(65.0%vs.25.0%;χ^2=4.800,P=0.029),while there was no significant difference in the incidence of symptomatic intracranial hemorrhage(10.0%vs.0%;P=0.516)and the fatality rate(10.0%vs.8.3%;P=1.000).There were significant differences in the baseline NIHSS score and the proportion of smoking and patients treated with EMT between the good outcome group and the poor outcome group.Multivariate logistic regression analysis showed that high baseline NIHSS score was independently associated with the poor outcome(odd ratio[OR]2.392,95%confidence interval[CI]1.190-4.810;P=0.014),while EMT was independently associated with good outcome(OR 0.038,95%CI 0.002-0.913;P=0.044).Conclusion EMT is safe and effective in the treatment of acute MCA M2 segment occlusion,which can significantly improve the clinical outcomes of patients.