血栓抽吸技术与支架取栓在急性大动脉闭塞性脑梗死患者中的应用对比

Comparison on the application of thrombus aspiration technique and stent-retriever thrombectomy in patients with acute aortic occlusive cerebral infarction

目的:研究血栓抽吸技术与支架取栓在急性前循环大动脉闭塞性脑梗死患者中的应用对比。方法:选择2020年1月~2021年6月于本院就诊的128例急性前循环大动脉闭塞性脑梗死患者,按治疗方案不同随机分为A组(n=46)和B组(n=40)和C组(n=42)。其中A组均接受血栓抽吸手术治疗,B组均接受支架取栓术治疗,C组于支架取栓术中联合应用小剂量替罗非班。比较不同组手术情况、血管再通前后血流评分变化、神经功能缺损恢复情况、术后并发症发生和近期临床预后结局。结果:A组手术总时长、血管再通时间短于B组、C组,平均取栓次数低于B组、C组,不同组血栓逃逸率、住院天数比较,差异无统计学意义;不同组血流评级结果比较,差异无统计学意义;B组术后90d内并发症发生率高于A组、C组,A组、C组术后并发症发生率比较无显著差异,不同组术后病死率比较,差异无统计学意义;不同组术后7d神经功能评分、术后3个月预后恢复评分比较,差异无统计学意义。结论:血栓抽吸技术与支架取栓均可使急性前循环大动脉闭塞性脑梗死患者显著获益,支架取栓术中应用小剂量替罗非班可减少术后并发症的发生风险,不同方案在血管再通效果、阻止血栓逃逸、改善预后生存、促进神经功能恢复等方面表现相近,但血栓抽吸技术手术时间和血管再通耗时更短。

Objective To study the application of thrombus aspiration technique and stent-retriever thrombectomy in patients with acute aortic occlusive anterior-circulation cerebral infarction.Methods A total of 128 patients with acute aortic occlusive anterior-circulation cerebral infarction treated in the hospital were enrolled between January 2020 and June 2021.According to different treatment methods,they were divided into group A (n=46,thrombus aspiration),group B (n=40,stent-retriever thrombectomy) and group C (n=42,stent-retriever thrombectomy combined with low-dose tirofiban).The surgical conditions,changes of blood flow scores before and after revascularization,recovery of neurological deficits,postoperative complications and short-term clinical prognosis in different groups were compared.Results The total operation time and revascularization time in group A were shorter than those in group B and group C,and average times of thrombectomy were fewer than those in group B and group C.There was no significant difference in thrombus escape rate or hospitalization time among the three groups.The difference in blood flow grading among the three groups was not statistically significant.The incidence of complications within 90d after surgery in group B was higher than that in groups A and C,but there was no significant difference in the incidence of postoperative complications between group A and group C.The difference in postoperative mortality rate among the three groups was not statistically significant.There was no significant difference in score of nerve function at 7d after surgery or score of prognosis recovery at 3 months after surgery among the three groups.Conclusion Both thrombus aspiration technique and stent-retriever thrombectomy can significantly treat patients with acute aortic occlusive anterior-circulation cerebral infarction.The application of low-dose tirofiban during stent-retriever thrombectomy can reduce the risk of postoperative complications.The different regimens are comparable in terms of revascularization effect,preventing thrombus escape,improving prognostic survival and promoting recovery of nerve function.However,operation time and revascularization time of thrombus aspiration technique are shorter.