伴大血管闭塞的急性前循环缺血性轻型卒中患者机械取栓治疗效果分析

Efficacy analysis of mechanical thrombectomy for acute anterior circulation ischemic minor stroke with large vessel occlusion

目的提高对伴大血管闭塞的急性前循环缺血性轻型卒中患者机械取栓的诊疗认识。方法收集2020年1月至2022年11月北京丰台右安门医院神经介入科收治的急诊卒中取栓患者中表现为前循环伴大血管闭塞的轻型卒中者,回顾性分析并总结此类患者的临床特点、机械取栓效果并随访预后。采用Wilcoxon秩和检验比较基线与90 d美国国立卫生研究院卒中量表(NIHSS)评分的差异。结果共17例患者入组,其中男性12例(70.6%),年龄为58(52,69)岁,以右侧发病为主(82.4%,14/17),Alberta卒中项目早期CT评分为10分者7例(41.2%,7/17),病因分型以大动脉粥样硬化型为主且均为颅内动脉粥样硬化性狭窄病变(82.4%,14/17),手术成功开通血管者16例(94.1%,16/17),术后颅内无症状出血者2例(11.8%,2/17)。90 d NIHSS评分低于基线NIHSS评分[1(0,2)分vs 4(3,4)分],差异具有统计学意义(Z=-2.386,P=0.017)。90 d随访良好预后率为88.2%(15/17)。结论机械取栓治疗作为伴大血管闭塞的急性前循环缺血性轻型卒中患者的治疗方案是可行的,并且有较高的安全性及血管再通率。

Objective To improve the understanding of the acute anterior circulation ischemic minor stroke with large vessel occlusion.Methods From 2020 Jan to 2022 Nov,17 patients with acute anterior circulation ischemic minor stroke and large vessel occlusion were admitted to You'anmen Hospital.They were all emergency thrombectomy cases.The clinical characteristics,effect of mechanical thrombectomy,and the prognosis of these patients were analyzed retrospectively.The difference between the baseline to the 90 d National Institute of Health stroke scale(NIHSS)score were compared using the Wilcoxon rank sum test.Results There were 17 patients in total,including 12 males(70.6%),with age of 58(52,69)years.14 cases of stroke occurred on the right side(82.4%).Patients with 10 scores in ASPECT score accounted for 41.2%.The etiological type was mainly large atherosclerosis and all of them were intracranial atherosclerosis stenosis(82.4%).16 patients were successfully recanalized(94.1%).2 patients got asymptomatic intracranial hemorrhage(11.8%).The difference between the 90 day and the baseline NIHSS score[1(0,2)vs 4(3,4)]was statistically significant(Z=-2.386,P=0.017).The 90 day follow-up data showed 88.2%had modified Rankin scale score 0-2.Conclusion Mechanical thrombectomy is feasible as a treatment for patients with acute anterior circulation ischemic minor stroke and large vessel occlusion,and has high safety and vessel recanalization rate.