急性大血管闭塞性轻型卒中血管内治疗的早期有效性和安全性分析

Analysis of early efficacy and safety of endovascular therapy for acute mild ischemic stroke with large vessel occlusion

目的·探讨急性大血管闭塞性轻型卒中(acute mild ischemic stroke with large vessel occlusion,LVO-MIS)血管内治疗(endovascular therapy,EVT)的早期有效性和安全性。方法·回顾性连续纳入2016年6月—2022年10月在上海交通大学医学院附属第六人民医院脑卒中绿色通道收治的急诊EVT辅助标准内科治疗的31例LVO-MIS患者(EVT组),以及同期仅采用标准内科治疗的32例LVO-MIS患者(对照组)。收集2组患者的一般临床资料和血管内治疗相关资料。其中,主要结局为早期有效,即治疗后第7日美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分(NIHSS at seventh day after treatment,d7NIHSS)较基线NIHSS评分下降≥3分或直接下降到0分;次要结局包括血管成功再通、早期神经功能恶化;安全性评价包括症状性颅内出血、死亡。对2组患者的主要结局、次要结局进行分析,以评估EVT早期有效性。对2组患者的安全性评价指标进行分析,以评估EVT的安全性。采用Kruskal-Wallis H检验对EVT组中24例实际行EVT的患者治疗前后的NIHSS评分进行分析。结果·2组患者的一般临床资料以及闭塞部位、发病至入院时间等血管内治疗相关资料间差异均无统计学意义。EVT组患者的基线NIHSS评分[5.0(3.0,5.0)分]高于对照组[3.5(2.0,5.0)分](P=0.001),其d7NIHSS评分[1.0(0,3.0)分]低于对照组[2.0(1.0,5.8)分](P=0.040)。2组患者中共有24例(38.1%)患者达早期有效,其中EVT组16例、对照组8例;且EVT组的有效率较对照组更高(χ^(2)=4.729,P=0.030)。EVT组患者的早期神经功能恶化率较对照组更低(χ^(2)=6.097,P=0.014),且EVT组中血管成功再通为29例(93.5%)。2组患者在症状性颅内出血率、死亡率间差异无统计学意义。EVT组中,24例患者基线NIHSS评分[5.0(3.0,5.0)分]、术后24 h的NIHSS评分[2.0(0.3,3.8)分]、d7NIHSS评分[1.0(0,2.8)分]间差异具有统计学意义(H=16.997,P=0.000)。结论·血管内治疗LVO-MIS是安全有效的;该疗法的早期效果优于标准内科治疗,早期神经功能恶化率更低且不增加症状性颅内出血的风险。

Objective·To investigate the early efficiency and safety of endovascular therapy(EVT)for patients with acute mild ischemic stroke with large vessel occlusion(LVO-MIS).Methods·A total of 31 patients with LVO-MIS who received emergency EVT-assisted standard medical treatment at the Green Channel of Stroke in Shanghai Sixth People's Hospital,Shanghai Jiao Tong University School of Medicine from June 2016 to October 2022 were retrospectively included as endovascular therapy group(EVT group),and 32 LVO-MIS patients who only received standard medical treatment in the same period were selected as the control group.General clinical data and parameters related to EVT of the two groups were collected.The primary outcome was early efficacy,that is,the NIHSS at seventh day after treatment(d7NIHSS)score decreased by≥3 points or directly to 0 points from baseline NIHSS score.Secondary outcomes included successful revascularization of blood vessels and early neurological deterioration(END),and safety outcomes included symptomatic intracranial hemorrhage(sICH)and mortality.The primary and secondary outcomes of the two groups of patients were analyzed to evaluate the early efficiency of EVT,and the safety evaluation indicators of the two groups of patients were analyzed to evaluate the safety of EVT.Kruskal-Wallis H test was used to analyze the NIHSS scores of 24 patients in the EVT group who underwent EVT before and after treatment.Results·There was no statistically significant difference in the general clinical data between the two groups,as well as parameters related to EVT such as occlusion site,and onset-to-admission time.The baseline NIHSS score of the EVT group[5.0(3.0,5.0)points]was higher than that of the control group[3.5(2.0,5.0)points](P=0.001),and their d7NIHSS score[1.0(0,3.0)points]was lower than that of the control group[2.0(1.0,5.8)points](P=0.040).A total of 24 patients(38.1%)in the two groups achieved early efficacy,including 16 cases in the EVT group and 8 cases in the control group;and the early efficacy rate of the EVT group was higher than that of the control group(χ^(2)=4.729,P=0.030).The END rate in the EVT group was lower than that in the control group(χ^(2)=6.097,P=0.014),and there were 29 cases(93.5%)in the EVT group of patients whose blood vessels were successfully reopened.There was no statistically significant difference in sICH rate and mortality rate between the two groups.In the EVT group,there was a statistically significant difference(H=16.997,P=0.000)among the baseline NIHSS scores[5.0(3.0,5.0)points]of 24 patients,postoperative 24hNIHSS score[2.0(0.3,3.8)points]and d7NIHSS scores[1.0(0,2.8)points].Conclusion·EVT is safe and effective in treating LVO-MIS,and the early efficacy rate of EVT is superior to standard medicine treatment,with a lower rate of END and no increased risk of sICH.