后循环颅内动脉粥样硬化狭窄急性闭塞血管内治疗的疗效分析

目的探讨后循环颅内动脉粥样硬化狭窄急性闭塞血管内治疗的有效性和安全性。方法回顾性分析2018年1月至2021年12月后循环急性大血管闭塞行血管内治疗患者87例,分为颅内动脉粥样硬化组(28例)和非颅内动脉粥样硬化组(59例),分析两组患者血管再通时间、手术时间、血管再通程度(mTICI)、术后颅内出血、术后严重脑梗死、死亡率、术后3个月mRS评分等临床指标。结果与非颅内动脉粥样硬化组比较,颅内动脉粥样硬化组年龄(P=0.017)、高血压(P=0.040)、吸烟史(P=0.020)、术前NIHSS评分(P=0.013)、侧支循环良好代偿(P=0.017)、术中行血管成形(P<0.001)、手术时间(P<0.001)差异有统计学意义。两组患者在血管再通时间、有效血管再通率、颅内出血发生率、术后严重梗死发生率、死亡率和90 d良好预后率差异无统计学意义。结论高血压、吸烟史是后循环颅内动脉粥样硬化狭窄急性闭塞的高危因素,后循环颅内动脉粥样硬化狭窄急性闭塞患者术前血管代偿相对良好,症状相对较轻,及时有效的血管内治疗是安全有效的。

Objective To investigate the efficacy and safety of endovascular treatment for emergent occlusion of posterior circulation intracranial atherosclerotic stenosis.Methods A retrospective analysis of 87 patients with posterior circulation emergent large vessel occlusion endovascular treatment in our hospital from January 2018 to December 2021,Divided into the intracranial atherosclerosis group(28 cases)and the non-intracranial atherosclerosis group(59 cases),statistical ananlysis clinical indicators such as recanalization time,operation time,degree of vascular recanalization(mTICI),postoperative intracranial hemorrhage,postoperative severe cerebral infarction,mortality,and modified Rankin scale(mRS)score at 3 months after operation were analyzed in both groups.Results Compared with the non-intracranial atherosclerosis group,the intracranial atherosclerosis group showed statistically significant differences in age(P=0.017),hypertension(P=0.040),smoking history(P=0.020),preoperative National Institutes of Health Stroke Scale(NIHSS)score(P=0.013),good collateral circulation compensation(P=0.017),intraoperative vascular angioplasty(P<0.001),and surgical duration(P<0.001).There were no significant differences in the vascular recanalization time,the rate of recanalization,the incidence of intracranial hemorrhage,the rate of postoperative severe cerebral infarction,mortality,and the rate of 90 days good prognosis in two groups.Conclusion Hypertension and smoking history are high-risk factors for emergent occlusion of posterior circulation intracranial atherosclerotic stenosis.There are better preoperative vascular compensation of patients with emergent occlusion of posterior circulation intracranial atherosclerotic stenosis,and the symptoms are relatively mild.Endovascular treatment is safe and effective for posterior circulation emergent large vessel occlusion.