栓塞性急性椎基底动脉闭塞首选取栓策略的比较研究

Preferred thrombectomy strategies for acute embolic occlusion of the vertebrobasilar artery:a comparative study

目的:探讨不同的首选取栓策略对栓塞性急性椎基底动脉闭塞(AVBAO)患者疗效的影响。方法:选择南阳市中心医院神经内科自2019年1月至2021年6月行血管内治疗的44例栓塞性AVBAO患者,根据首选取栓策略的不同将患者分为支架取栓组(27例)和抽吸取栓组(17例),术后90 d采用改良Rankin量表(mRS)评分评估患者的预后。比较2组患者临床资料、手术相关特征、预后及并发症发生情况的差异。结果:2组患者的发病至穿刺时间、靶血管闭塞部位、术中使用补救措施者所占比例、靶血管成功再通率的差异均无统计学意义(P>0.05)。与抽吸取栓组比较,支架取栓组患者中间导管使用率较低,取栓次数较多,靶血管首次取栓再通率较低,穿刺至再通时间较长,新发栓塞的发生率较高,差异均有统计学意义(P<0.05)。2组患者血管破裂、术后症状性颅内出血(sICH)发生率及术后90 d预后良好率的差异均无统计学意义(P>0.05)。结论:对于栓塞性AVBAO患者,首选抽吸取栓可取得与支架取栓相近的血管再通率及短期预后良好率,同时具有再通时间短、新发栓塞并发症少、首次取栓再通率高等优点。

Objective To investigate the efficacy of different preferred thrombectomy strategies for embolic acute vertebrobasilar artery occlusion(AVBAO).Methods Forty-four patients with embolic AVBAO who underwent endovascular treatment in Department of Neurology,Nanyang Central Hospital from January 2019 to June 2021 were included in the study.Patients were divided into stent-retriever thrombectomy group(n=27)and aspiration thrombectomy group(n=17)according to different preferred thrombectomy strategies.Modified Rankin scale(mRS)was used to evaluate the prognoses of these patients 90 d after surgery;the differences of clinical data,surgery-related characteristics,prognoses and complications between the two groups were compared.Results There was no significant difference between the 2 groups in terms of time from onset to puncture,sites of target vessel occlusion,proportion of patients accepted intraoperative remedial measures,and successful recirculation rate of target vessels(P>0.05).Compared with the aspiration thrombectomy group,the stent-retriever thrombectomy group had significantly decreased utilization rate of middle catheters,significantly increased retrieval attempts in thrombectomy,statistically lower re-recanalization rate of first-time thrombectomy on the target vessels,significantly longer time from puncture to re-recanalization,and significantly higher incidence of new embolism(P<0.05).There was no significant difference between the 2 groups in incidences of vascular rupture and postoperative spontaneous intracerebral hemorrhage(sICH),and good prognosis rate 90 d after surgery(P>0.05).Conclusion For embolic AVBAO patients,similar recanalization and short-term good prognosis can be obtained by aspiration thrombectomy to those by stent-retriever thrombectomy;besides that,aspiration thrombectomy has advantages as shorter recanalization time,less new embolic complications and higher re-recanalization rate of first-time thrombectomy.