机械取栓术治疗不同基底动脉闭塞亚型的疗效比较

Comparison of efficacy of mechanical thrombectomy for the treatment of different subtypes of basilar arteryocclusion

目的比较机械取栓术治疗不同基底动脉闭塞亚型的疗效。方法回顾性分析2019年1月至2022年6月大连市中心医院神经介人及神经重症科经机械取栓术治疗的96例基底动脉闭塞所致急性缺血性卒中患者的临床资料,根据卒中的机制分为三组:基底动脉栓塞无椎动脉狭窄组(第1组,33例)、椎动脉狭窄伴基底动脉闭塞组(第2组,30例)、基底动脉内原位动脉粥样硬化性血栓形成组(第3组,33例)。术后行全脑数字减影血管造影检查,并根据改良脑梗死溶栓(mTICI)分级评价血管再通情况;行头颅CT检查评估有无颅内出血;术后90d采用改良Rankin量表评分(mRS)评估患者的预后;比较三组患者的基线资料、血管再通率、手术时长、术后并发症等情况。结果三组患者术前的基线资料比较结果显示,不同亚型缺血性卒中患者的性别、年龄等差异均无统计学意义(均P>0.05);基底动脉闭塞部位、高脂血症、心房颤动的差异均具有统计学意义(均P<0.05)。96例患者的血管内治疗均顺利完成,其中,91例(94.8%)血管再通成功;三组患者首选血管内治疗的方式、血管再通率的差异均无统计学意义(均P>0.05)。与第1组相比,第2、3组发病至股动脉穿刺时长、手术时长、发病至再通时长均延迟,差异均有统计学意义(均P<0.05)。96例患者均接受术后90d的临床随访,其中31例(32.3%)预后良好(mRS≤2分);三组患者预后良好、死亡、术后并发症等差异均无统计学意义(均P>0.05)。多因素logistic回归分析结果显示,校正发病至再通时间后,组别与临床良好预后结果无关(P=0.132)。结论不同基底动脉闭塞亚型经个体化机械取栓术治疗后发病至再通的时长可能不同,但其总的疗效相当;基底动脉栓塞无椎动脉狭窄的患者血管成功再通所需的时间较短,但其与预后良好无关。

Objective To compare the efficacy of mechanical thrombectomy for the treatment of different subtypes of basilar artery occlusionM.ethodsThe clinical data of 96 patients with acute ischemic stroke caused by basilar artery occlusion treated in the Department of Neurointervention and Neurointensive Care of Dalian Municipal Central Hospital from January 2019 to June 2022 were retrospectively analyzed.The patients were divided into three groups according to the pathological subtypes of stroke mechanism:embolization without vertebral artery stenosis(group 1,33 cases),vertebral artery stenosis with basilar artery occlusion(group 2,30 cases),and in situ atherosclerotic thrombosis in the basilar artery(group 3,33 cases).Whole-brain digital subtraction angiography was performed after surgery,and the revascularization was evaluated according to modified cerebral infarction thrombolysis(mTICI)grading system.Cranial CT was performed to evaluate intracranial hemorrhage.The outcome of patients was evaluated by modified Rankin scale(mRS)90 days after surgery.The baseline data,recurrence rate,operation time and postoperative complications of the three groups were compared.Results The preoperative baseline data of the three groups showed no statistical significance in the sex,age,etc among patients with dfferent mechanisms of ischemic stroke(all P>0.05).Basilar artery occlusal site,hyperlipidemia,atrial fibrillation and other factors had statistical significance(all P<0.05).All the 96 patients underwent endovascular therapy successfully,91 cases(94.8%)had successful recanalization.There was no significant difference in the preferred endovascular treatment and the vascular recanalization rate among the three groups(all P>0.05).The time from onset to puncture,operation time,onset to recirculation time in groups 2 and 3 were longer than those in group 1,and the differences were statistically significant(all P<0.05).All patients were followed up 90 days after surgery,31 cases(32.3%)had good outcomes(mRS≤2 points)and there were no significant differences in proportion of good outcomes,death or postoperative complications among the three groups(all P>0.05).Multivariate logistic regression analysis showed that after adjusting the time from onset to recanalization,different groups were not associated with good clinical outcomes(P=0.132).Conclusions The time from puncture to recanalization of different subtypes of basilar artery occlusion may be different after individualized mechanical thrombectomy,but the effects of mechanical thrombectomy are similar.Basilar artery occlusion patients without vertebral artery stenosis have a shorter time interval to successful recalculation,but this is not associated with favorable prognosis.