多模式磁共振选择指导下超时间窗急诊血管内介入治疗前循环大动脉闭塞患者的临床疗效及预后分析

Clinical efficacy and prognosis analysis of patients with anterior circulation large artery occlusion in emergency endovascular interventional therapy out of time window under the guidance of multimode MR selection

目的 探讨多模式磁共振(MR)选择指导下超时间窗急诊血管内介入治疗对前循环大动脉闭塞患者的治疗效果。方法 选取2019年1月至2020年1月我院收治的前循环大动脉闭塞患者104例,其中46例发病时间为>6 h(>6 h组),58例发病时间≤6 h(≤6 h组),两组均在多模式MR选择指导下进行血管内介入治疗。比较两组治疗后90 d临床疗效,两组治疗后24 h、48 h、7 d NIHSS评分,治疗后72 h高敏C反应蛋白(hs-CRP)、白介素-6(IL-6);以及两组预后情况[血管再通良好、颅内出血、90 d改良Rankin评分(mRS)]。结果 治疗后90 d,>6 h组总有效率67.39%,≤6 h组为81.03%,两组比较差异无统计学意义(P>0.05);治疗后两组24 h、72 h、7 d NIHSS评分均较治疗前下降,而>6 h组与≤6 h组比较差异无统计学意义(P>0.05);治疗后24 h两组hs-CRP、IL-6水平较治疗前降低(P<0.05),但组间差异无统计学意义(P>0.05);两组血管再通良好、颅内出血、mRS评分比较差异无统计学意义(P>0.05)。结论 对超时间窗前循环大动脉闭塞患者在多模式MR选择指导下进行血管内介入治疗安全有效。

Objective To analyze the therapeutic effect of patients with anterior criculation large artery occlusion in emergency endovascular interventional therapy out of time window under the guidance of multimodal MR selection.Methods One hundred and four patients with anterior circulation large artery occlusion admitted to our hospital from January 2019 to January 2020 were selected. Among them, 46 patients had onset time > 6 hours(>6 h group), and 58 patients had onset time ≤ 6 hours(≤6 h group). Both groups underwent endovascular interventional therapy under the guidance of multimodal MR selection. The clinical efficacy after 90 days of treatment, the NIHSS scores after 24 and 48 hours, and 7 days of treatment, the 72 hour high sensitive C-reactive protein(hs-CRP) and interleukin(IL-6) after treatment and the prognosis such as good vascular recanalization, intracranial hemorrhage and 90 day modified Rankin score(mRS) were compared between the two groups.Results After 90 days of treatment, the total effective rate was 67.39% in the >6 h group and 81.03% in the ≤6 h group. The difference was not significant(P>0.05). The NIHSS scores of the two groups were decreased after 24 and 72 hours and 7 days of treatment, but there was no difference between the two groups(P>0.05). The levels of hs-CRP and IL-6 in the two groups were lower than those before treatment(P<0.05), and there was no difference between the two groups(P>0.05). There was no difference in the blood vascular recanalization, intracranial hemorrhage and mRS score between the two groups(P>0.05).Conclusion Endovascular interventional therapy out of time window under the guidance of multimodal MR selection is safe and effective for patients with anterior circulation large artery occlusion.