超选择性动脉溶栓联合Solitaire AB支架取栓治疗大动脉粥样硬化型脑梗死的临床效果

Clinical effect of superselective intra-arterial thrombolysis combined with solitaire AB stent in the treatment of large atherosclerotic cerebral infarction

目的探讨超选择性动脉溶栓联合Solitaire AB支架取栓治疗大动脉粥样硬化(Large artery atherosclerosis, LAA)型脑梗死的临床效果。方法选择本院2017年1月-2020年8月收治的LAA型脑梗死患者98例,按照随机数字表法分为2组,每组各49例,2组患者均接受急性脑梗死的常规治疗,在此基础上对照组接受超选择性动脉溶栓治疗,联合组接受超选择性动脉溶栓联合Solitaire AB支架取栓;比较2组治疗前、治疗后第1、3、7 d美国国立卫生研究院卒中量表(National institutes of health stroke scale, NIHSS)评分;比较2组治疗前后血清内皮细胞特异性分子(Endothelial cell specific molecule, Endocan)、血管内皮细胞钙黏蛋白(Vascular endothelial-cadberin, VE-Ca)水平;比较2组血管再通率、总有效率和不良反应发生率。结果治疗后第3、7 d联合组NIHSS评分均低于对照组(P<0.05);联合组血管再通率、总有效率高于对照组;治疗后第30 d血清Endocan, VE-Ca水平低于对照组(P<0.05);2组不良反应发生率无明显差异(P>0.05)。结论选择性动脉溶栓联合Solitaire AB支架取栓可提高血管再通率,改善神经功能缺损症状,降低血清Endocan, VE-Ca水平,减轻血管炎症反应,保护血管内皮功能,治疗LAA型脑梗死效果确切,安全性好。

Objective To investigate the clinical effect of superselective arterial thrombolysis combined with solitaire AB stent thrombectomy in the treatment of large artery atherosclerosis(LAA) cerebral infarction.Methods 98 patients with LAA type cerebral infarction in our hospital from January, 2017 to August, 2020 were selected and randomly divided into two groups, with 49 cases in each group. The patients the both groups received conventional treatment of acute cerebral infarction. The control group received super selective arterial thrombolysis, and the combined group received super selective arterial thrombolysis combined with solitaire AB stent thrombectomy. The NIHSS scores were compared before treatment and in 1 D, 3 D and 7 d after treatment, and the levels of serum endothelial cell specific molecule(Endocan) and vascular endothelial cell cadherin(VE-CA) were compared between the two groups before and after treatment, and the vascular recanalization rate, the total effective rate and incidence of adverse reactions were compared between the two groups.Results The NIHSS score of the combined group was lower than that of the control group in 3 days and 7 days after treatment(P<0.05);The recanalization rate and the total effective rate of the combined group were higher than those of the control group, and the serum endocan and ve Ca levels after treatment were lower than those of the control group(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Selective intra-arterial thrombolysis combined with solitaire AB stent thrombectomy can improve vascular recanalization rate, improve neurological deficit symptoms, decrease the level of Endocan、VE-Ca, reduce he inflammatory response of blood vessels and protect vascular endothelial function. It is effective and safe in the treatment of LAA type cerebral infarction.