支架植入联合颅内取栓对颈动脉串联病变所致脑梗死患者首通效应及预后影响

Effects of intracranial stent-retriever based mechanical thrombectomy on first-pass effect and prognosis in patients with cerebral infarction following carotid artery tandem lesion

目的探讨支架植入联合颅内取栓对颈动脉串联病变所致脑梗死患者首通效应及预后的影响。方法回顾性分析自2021年6月至2022年6月于临汾市中心医院就诊的93例颈动脉串联病变致脑梗死患者的临床资料。根据病变处理顺序将所有患者分为优先取栓组(n=57)与优先植入组(n=36)。比较两组患者的股动脉穿刺至血管再通时间、手术期间1次取栓成功率、血管成功再通率、术后24 h美国国立卫生研究院卒中量表(NIHSS)评分、术后7 d的NIHSS评分、术后90 d改良Rankin量表(mRS)评分、术后90 d预后良好率,以及症状性颅内出血、血管再闭塞、术后90 d病死率、不良反应总发生率。结果两组患者均顺利完成手术,术后血管再通率均为100.0%。优先取栓组患者的股动脉穿刺至血管再通时间短于优先植入组,术中1次取栓成功率高于优先植入组,组间比较,差异均有统计学意义(P<0.05)。两组患者术后90 d的mRS评分平均值均>2分。两组患者的术后24 h的NIHSS评分、术后7 d的NIHSS评分、术后90 d的mRS评分及术后90 d的预后良好率比较,差异均无统计学意义(P>0.05)。两组患者术后出现症状性颅内出血、血管再闭塞、术后90 d死亡的发生率和不良反应总发生率比较,差异均无统计学意义(P>0.05)。结论支架植入联合颅内取栓治疗颈动脉串联病变所致脑梗死患者时,优先取栓及优先植入支架这两种手术策略均可行,但优先进行机械取栓,患者的1次取栓成功率更高,血管再通更快。

Objective To investigate the effect of stent implantation combined with intracranial thrombectomy on first-pass effect and prognosis of patients with cerebral infarction caused by carotid artery tandem lesion.Methods The clinical data of 93 patients with cerebral infarction caused by carotid artery tandem lesion treated in Linfen Central Hospital from June 2021 to June 2022 were retrospectively analyzed.All patients were divided into priority thrombectomy group(n=57)and priority implantation group(n=36)according to the sequence of lesion management.The time from femoral artery puncture to vascular recanalization,the success rate of thrombal removal during surgery,the rate of successful vascular recanalization,the score of national institutes of health stroke scale(NIHSS)24 hours after surgery,the score of NIHSS 7 days after surgery,the score of modified Rankin scale(mRS)90 days after surgery,and the rate of good prognosis 90 days after surgery were compared between the two groups.Symptomatic intracranial hemorrhage,vascular reocclusion,mortality 90 days after surgery,and the total incidence of adverse reactions.Results The operation was successfully completed in both groups,and the rate of vascular recirculation was 100.0%.The time from femoral artery puncture to vascular recanalization in the priority thrombectomy group was shorter than that in the priority implantation group,and the success rate of one intraoperative thrombectomy was higher than that in the priority implantation group,with statistical significance between two groups(P<0.05).The mean mRS scores of the two groups at 90 days after surgery were more than 2 points.There was no statistical significance in NIHSS score at 24 hours after surgery,NIHSS score at 7 days after surgery,mRS score at 90 days after surgery and good prognosis rate at 90 days after surgery between the two groups(P>0.05).There was no statistical significance in the incidence of symptomatic intracranial hemorrhage,vascular reocclusion,death and the total incidence of adverse reactions 90 days after surgery between two groups(P>0.05).Conclusion Application of intracranial stent-retriever based mechanical thrombectomy in patients with cerebral infarction following carotid artery tandem lesion is feasible with either a preferential thrombolysis or a preferential stent implantation surgical strategy,while the preferential mechanical thrombectomy has high success rate in the first attempt of intraoperative thrombectomy and quick vascular recanalization.