急性前循环大血管闭塞缺血性脑卒中直接机械取栓的疗效分析

Analysis on direct mechanical thrombectomy for acute ischemic stroke with large vessel occlusion in anterior circulation

目的探讨急性前循环大血管闭塞(aLVO)性脑卒中直接机械取栓治疗的临床疗效及安全性。方法59例发病时间在4.5 h内的前循环大血管急性闭塞患者,随机分至直接取栓组(29例)和静脉溶栓联合机械取栓组(桥接治疗组,30例)。分析比较两种治疗方法患者治疗后血管开通、术后90 d神经功能预后良好(改良Rankin量表评分0~2分)及症状性颅内出血、死亡的比率。结果直接取栓组与桥接治疗组患者的血管开通率(89.7%vs 90.0%)和术后90 d预后良好率(41.4%vs 43.3%)比较,差异无统计学意义(均P>0.05)。直接取栓组与桥接治疗组患者症状性颅内出血发生率(6.90%vs 10.0%)和死亡率(13.8%vs 16.7%)的差异亦均无统计学意义(均P>0.05)。结论对发病在4.5 h内的前循环大血管急性闭塞患者,直接机械取栓与桥接治疗均具有较好的疗效及安全性,两者无明显差异。直接机械取栓可作为前循环大血管急性闭塞患者的有效治疗措施。

Objective To investigate the clinical efficacy and safety of direct mechanical thrombectomy in the treatment of acute anterior circulation large vessel occlusion(aLVO)stroke.Methods 59 patients with acute occlusion of anterior circulation within 4.5 hours were randomly divided into direct thrombolysis group(n=29)and intravenous thrombolysis combined with mechanical thrombolysis group(n=30).The rates of vascular patency,good neurological prognosis90 days after operation(modified Rankin Scale score 0-2),symptomatic intracranial hemorrhage and death were analyzed and compared.Results There was no significant difference in the vascular patency rate(89.7%vs 90.0%)and 90 day prognosis rate(41.4%vs 43.3%)between the two groups(all P>0.05).There was no significant difference in the incidence of symptomatic intracranial hemorrhage(6.90%vs 10.0%)and mortality(13.8%vs 16.7%)between the two groups(all P>0.05).Conclusions For patients with acute anterior circulation occlusion within4.5 hours,direct mechanical thrombectomy and bridging therapy have good efficacy and safety,and there is no significant difference between them.Direct mechanical thrombectomy can be used as an effective treatment for patients with acute anterior circulation occlusion.