支架机械取栓术治疗前循环M2、A2段急性血管闭塞的临床疗效分析

Clinical efficacy analysis of mechanical stent thrombectomy in the treatment of acute vascular occlusion of anterior circulation M2 and A2 segments

目的探讨支架机械取栓术治疗前循环大脑中动脉(MCA)M2段、大脑前动脉(ACA)A2段急性血管闭塞的有效性、安全性,分析其危险因素。方法纳入2020年5月至2022年2月在该院神经内科接受治疗的MCA M2段、ACA A2段急性血管闭塞患者共40例。据患者及家属意愿、临床决策分为支架机械取栓组(n=17)和药物治疗组(n=23)。主要评价2组患者治疗后90 d的改良Rankin量表(mRS)评分,以及并发症发生情况、死亡率,分析危险因素。结果支架机械取栓组患者治疗后90 d mRS评分明显低于药物治疗组,差异有统计学意义(P<0.05)。基于倾向性得分加权的logistic回归模型显示,支架机械取栓组出现90 d mRS评分大于2分的风险低于药物治疗组,差异有统计学意义[OR支架机械取栓组=0.344,95%CI(0.121,0.977),P=0.045]。结论支架机械取栓术治疗MCA M2段、ACA A2段急性闭塞,尤其是MCA M2段急性闭塞,安全、有效,可能是良好预后的保护性因素。

Objective To investigate the efficacy and safety of mechanical stent thrombectomy in the treatment of acute vascular occlusion of the M2 segment of the anterior circulation middle cerebral artery(MCA)and the A2 segment of the anterior cerebral artery(ACA),and analyze its risk factors.Methods From May 2020 to February 2022,a total of 40 patients with acute vascular occlusion of MCA M2 segment and ACA A2 segment who received treatment in the department of neurology of the hospital were enrolled.According to the wishes of patients and their families,and clinical decision,they were divided into the mechanical stent thrombectomy group(n=17)and the drug treatment group(n=23).The modified Rankin Scale(mRS)score at 90 days after treatment,complications and mortality in the two groups were mainly evaluated,and risk factors were analyzed.Results The 90-days mRS score in the mechanical stent thrombectomy group was significantly lower than that in the drug treatment group,and the difference was statistically significant(P<0.05).The logistic regression model based on propensity score weighting showed that the risk of 90-days mRS score>2 points in the mechanical stent thrombectomy group was lower than that in the drug treatment group,and the difference was statistically significant[OR of the mechanical stent thrombectomy group=0.344,95%CI(0.121,0.977),P=0.045].Conclusion The mechanical stent thrombectomy is safe and effective in the treatment of MCA M2 segment,ACA A2 segment acute occlusion,especially MCA M2 segment acute occlusion,and may be a protective factor for good prognosis.