前循环串联病变的血管再通顺序对急性缺血性卒中短期预后的影响

Effect of recanalization sequence of anterior circulatory tandem lesions on short-term prognosis of acute ischemic stroke

目的:探讨前循环串联病变血管再通顺序对急性缺血性卒中(AIS)患者短期预后的影响。方法:回顾性队列研究。纳入2018年1月—2019年6月中国医科大学附属第四医院神经内科因前循环串联病变导致AIS并行血管内介入治疗的40例患者的临床资料,其中男36例、女4例,年龄39~78岁。根据不同的再通顺序将患者分为2组:A组26例,采用球囊扩张-取栓-颈动脉支架方法;B组14例,采用球囊扩张-颈动脉支架-取栓方法。观察两组患者的发病到穿刺时间、穿刺到靶血管再通时间、血管再通情况、联合静脉溶栓的桥接治疗例数、闭塞部位、症状性颅内出血等,术后90天采用改良Rankin量表(mRS)评分评估患者短期预后并进行组间对比分析。结果:两组患者年龄、性别构成、入院时美国独立卫生研究院卒中量表(NIHSS)评分等基线资料比较,差异均无统计学意义( P值均>0.05)。两组患者的发病到穿刺时间、血管再通情况、联合静脉溶栓的桥接治疗例数、闭塞部位、症状性颅内出血情况,以及术后3个月短期预后评分比较,差异均无统计学意义( P值均>0.05);A组穿刺到靶血管再通时间较B组更短,分别为43.7(43.75,59)和66.5(38,68.25)min,差异有统计学意义( Z=-4.004, P<0.01)。术后90天A组mRS评分0~4分,预后良好15例(57.7%,15/26),B组mRS评分1~5分,预后良好9例(9/14),两组术后短期预后良好率比较,差异无统计学差异(χ 2=0.165, P>0.05)。 结论:球囊扩张-取栓-颈动脉支架与球囊扩张-颈动脉支架-取栓两种不同的再通顺序,对AIS患者的短期预后影响无明显差异,只是前者穿刺到靶血管再通所需要的时间更短。

Objective To investigate the effect of recanalization sequence of anterior circulation on the short-term prognosis of acute ischemic stroke.Methods The retrospective cohort study was conducted.Clinical data of 40 patients with AIS and endovascular interventional therapy due to anterior circulation tandem lesions in the Department of Neurology,the Fourth Affiliated Hospital of China Medical University from January 2018 to June 2019 were included,including 36 males and 4 females,aged 39-78 years.According to different recanalization order,the patients were divided into two groups:group A(balloon dilatation-thrombectomy-carotid artery stent group)with 26 cases,and group B(balloon dilatation-carotid artery stent-thrombectomy group)with 14 cases.The time from onset to puncture,the time from puncture to target vessel recanalization,the situation of vascular recanalization,bridging therapy combined with intravenous thrombolysis,the location of occlusion,and symptomatic intracranial hemorrhage in the two groups were analyzed.The short-term prognosis of the patients was evaluated by modified Rankin scale(mRS)score at 90 days after surgery,and a comparative analysis was conducted between the two groups.Results There were no significant differences in baseline data between the two groups,such as age,gender composition,National Institutes of Health stroke scale(NIHSS)score at admission(all P values>0.05).There were no significant differences in the time from onset to puncture,recanalization of vessels,bridging therapy combined with intravenous thrombolysis,occlusion site,symptomatic intracranial hemorrhage,and short-term prognosis score 3 months after operation between the two groups(all P values>0.05).The time from puncture to target vessel recanalization in group A was shorter than that in group B(43.7[43.75,59]min and 66.5[38,68.25]min,respectively),and the difference was statistically significant(Z=-4.004,P<0.01).Ninety days after surgery,the mRS score of group A was 0-4,and 15 patients(57.7%,15/26)had good prognosis.the mRS score of group B was 1-5,and 9 patients(9/14)had good prognosis.There was no statistically significant difference in the rate of good short-term prognosis between the two groups(χ2=0.165,P>0.05).Conclusions The recanalization sequence of balloon dilatation-thrombectomy-carotid artery stent and balloon dilatation-carotid artery stent-thrombectomy have no significant effect on the short-term prognosis of AIS patients.But the time required for the former puncture to the target vessel recanalization is shorter.