药物洗脱支架在急性大脑中动脉粥样硬化闭塞性卒中患者急诊血管成形术中的临床疗效

Clinical efficacy of drug-eluting stents in emergency angioplasty for patients with acute middle cerebral artery atherosclerotic occlusive stroke

目的探讨药物洗脱支架(DES)治疗急性大脑中动脉粥样硬化闭塞性卒中的安全性及有效性。方法回顾性分析2021年12月5日至2023年3月1日在西电集团医院、咸阳市第一人民医院、西京医院、陕西省人民医院、西安市中心医院、西安大兴医院、西安市北方医院收治的急性大脑中动脉粥样硬化性闭塞所致卒中行急诊颅内DES治疗的34例患者的临床资料,观察患者的临床基线特征、影像学特点[CT-Alberta卒中项目早期CT评分(ASPECTS)、弥散加权成像(DWI)-ASPECTS、CT灌注成像(CTP)]、手术效果和围手术期情况[患者入院到股动脉穿刺成功时间(DPT)、术后改良脑梗死溶栓(mTICI)分级、症状性颅内出血(sICH)、术后即刻美国国立卫生研究院卒中量表(NIHSS)评分、术后24 h NIHSS评分、术后30 d NIHSS评分、术后30 d改良Rankin量表(mRS)评分]、临床预后随访(术后90 d mRS评分、术后90 d内脑卒中复发率、死亡率)以及术后90 d支架内再狭窄发生率。采用t检验比较基线NIHSS、mRS评分和术后30 d NIHSS、mRS评分的差异。结果34例患者年龄为(64.6±6.5)岁,男性24例(70.6%),合并高血压者27例(79.4%)、糖尿病17例(50.0%)、高脂血症12例(35.3%)、高同型半胱氨酸血症12例(35.3%)、心房纤颤0例、吸烟者20例(58.8%);发病至就诊时间为(8.9±4.6)h,基线NIHSS评分为(7.9±1.1)分,基线mRS评分为(2.7±1.1)分;CT-ASPECTS评分为(9.8±0.4)分,DWI-ASPECTS评分为(8.0±1.0)分,右侧大脑中动脉闭塞者22例(64.7%),左侧大脑中动脉闭塞者12例(35.3%),CTP平均错配体积为(96.5±30.1)ml。34例患者术后即刻均达到mTICI分级3级,成功再通率为100%;术后1例发生无症状性颅内出血,sICH发生率为0;术后30 d NIHSS评分为(3.6±2.3)分,较基线下降,差异具有统计学意义(t=3.975,P=0.001);术后30 d mRS评分为(1.6±0.8)分,较基线下降,差异具有统计学意义(t=2.24,P=0.038)。术后90 d随访显示85.7%(29/34)的患者获得良好临床预后(mRS评分0~2),无死亡患者,无缺血性卒中复发患者,无支架内再狭窄发生。结论对急性大脑中动脉粥样硬化闭塞性卒中患者行DES治疗是安全有效的,短期随访支架内再狭窄率低。

Objective To observe the safety and effectiveness of drug-eluting stent(DES)in the treatment of acute middle cerebral artery occlusive stroke.Methods Retrospective analysis on December 5,2021 to March 1,2023 in the XD Group Hospital,Xianyang First People's Hospital,Xi'an Central Hospital,Xijing Hospital,Shaanxi Provincial People's Hospital,Xi'an Northern Hospital,and Xi'an DaXing Hospital seven Hospitals acute middle cerebral artery stroke caused by atherosclerotic occlusion underwent emergency treatment of the clinical data of 34 patients with intracranial DES,Clinical baseline characteristics imaging characteristics(CT-Aspects,DWI-Aspects,CTP)were observed.Surgical situation(DPT,TICI,sICH,NIHSS score immediately after surgery,NIHSS score 24 hours after surgery,NIHSS score 30d after surgery,and mRS score 30 d after surgery),clinical prognosis(mRS score 90 d after surgery,stroke recurrence rate and death rate within 90d after surgery)and incidence of in-stent restenosis 90 days after surgery.Differences in the baseline NIHSS,the mRS score,and the postoperative 30 d NIHSS and the mRS score were compared by t-test.Results The average age of the 34 patients was(64.6±6.5)years old,including 24 males(70.6%),27 patients with hypertension(79.4%),17 patients with diabetes(50.0%),12 patients with hyperlipidemia(35.3%),12 patients with high homocysteine(35.3%),0 patients with atrial fibrillation,and 20 patients with smokers(58.8%).The mean onset time was(8.9±4.6)hours,the baseline NIHSS score was 7.9±1.1,and the baseline mRS score was 2.7±1.1.CT-ASPECTS score was 9.8±0.4,DWI-ASPECTS score was 8.0±1.0.There were 22 cases(64.7%)of right middle cerebral artery occlusion and 12 cases(35.3%)of left middle cerebral artery occlusion.The mean CTP mismatched volume was(96.5±30.1)ml.34 patients reached mTICI grade 3 immediately after surgery,and the successful replantation rate was 100%.After operation,one patient had asymptomatic intracranial hemorrhage,and the incidence of sICH was 0%.The NIHSS score at 30 days after operation was 3.6±2.3,which was lower than baseline,and the difference was statistically significant(t=3.975,P=0.001).The mRS score at 30 d after operation was 1.6±0.8,lower than baseline,and the difference was statistically significant(t=2.24,P=0.038).90-day postoperative follow-up showed that 85.7%(29/34)of the patients had a good clinical prognosis(mRS score 0-2),no patients died,no patients with recurrent ischemic stroke,and no intrastent restenosis occurred.Conclusion DES treatment is safe and effective in patients with acute mid-cerebral atherosclerotic occlusive stroke,and the restenosis rate is low in short-term follow-up.