急性缺血性脑卒中血管内介入治疗的预后观察

Prognosis of intravascular interventional therapy for acute ischemic stroke

目的回顾性分析急性缺血性脑卒中患者取栓术后的预后,探讨影响预后的因素。方法选取2019年9月至2022年1月宜宾市第一人民医院神经内科接受血管内介入治疗的64例急性卒中患者为研究对象;收集患者基本信息、改良脑梗死溶栓血流分级(modified Thrombolysis in Cerebral Infarction,mTICI)、美国国立卫生研究院卒中量表评分(National Institute of Health Stroke Scale,NIHSS)、Modified Rankin Scale(mRS)评分等;术后复查头颅CT平扫评估脑组织是否存在造影剂外渗、颅内出血、脑水肿等并发症。结果28例患者接受了支架取栓、抽吸取栓治疗,其中19例实现了血管再通,血管再通率为67.9%;32例患者接受了动脉内注射替罗非班抗血小板治疗,其中10例实现了血管再通,血管再通率为31.3%;术后24小时有47例患者的NIHSS评分减分率不足18%,占比73.4%。术后3个月随访29例血管再通的患者发现,恢复较好(mRS评分≤2分)的患者有15人,占比51.7%;28例接受了机械取栓的患者有10例在术后即刻复查头颅CT检查发现了不同程度的造影剂外渗或者颅内出血。结论在开展急诊血管内介入手术时,对于血管再通患者的术后预后不可盲目乐观,还需要谨慎判定。

Objective To retrospectively analyze the prognosis of patients with acute 64 patients ischemic stroke after intravascular interventional therapy,and discuss the factors that affecting the prognosis.Methods From September 2019 to January 2022,acute stroke patients that receiving endovascular intervention in the department of Neurology were collected,including basic information,mTICI,NIHSS,mRS,etc.Postoperative head CT scan was performed to evaluate the presence of contrast extravasation,intracranial hemorrhage,cerebral edema and other complications.Results 28 patients received interventional thrombectomy.19 of them got vascular recanalization,and the rate of vascular recanalization was 67.9%.32 patients received intra-arterial Tirofiban therapy.10 patients got vascular recirculation,and the rate of vascular recirculation was 31.3%.After 24 hours,the reduction rate of NIHSS score in 47 patients was less than 18%.After 3 months,29 patients with vascular recanalization were followed up and found that there were only 15 patients with good recovery(mRS Score≤2).Among the 28 patients who received interventional thrombectomy,10 cases were found that there were different degrees of contrast extravasation or intracranial hemorrhage immediately after surgery.Conclusion During emergency endovascular interventional surgery,the postoperative prognosis of patients with recanalization should not be blindly optimistic,and should also be determined to base on the local actual situation.