急性后循环大动脉闭塞桥接治疗与直接机械取栓的疗效及安全性

Efficacy and safety of bridging therapy and direct mechanical thrombectomy for acute posterior circulation arterial occlusion

目的观察急性后循环大动脉闭塞桥接治疗(BT)与直接机械取栓(DMT)的疗效及安全性。方法回顾性分析2020-06—2023-05海口市人民医院收治的120例急性后循环大动脉闭塞患者的临床资料,根据治疗方法的不同分为2组,采用DMT治疗62例纳入DMT组,采用BT治疗58例纳入BT组,比较2组患者治疗情况、血管再通率、神经功能缺损程度(NIHSS)评分、格拉斯哥昏迷量表(GCS)评分、预后良好率及出血转化、症状性颅内出血发生率和病死率。结果BT组血管再通率为84.48%,高于DMT组的80.65%,但组间比较无统计学差异(P>0.05)。治疗后14 d,BT组患者NIHSS、GCS评分为(9.28±1.63)分、(12.57±2.60)分,DMT组患者NIHSS、GCS评分为(8.93±1.50)分、(13.15±2.87)分,组间比较无统计学差异(P>0.05)。BT组治疗后90 d的预后良好率为48.28%,高于DMT组的41.94%,但组间比较无统计学差异(P>0.05)。BT组术后出血转化发生率为34.48%,高于DMT组的14.52%(P<0.05),2组患者症状性颅内出血和90 d病死率比较无统计学差异(P>0.05)。结论BT和DMT治疗急性后循环大动脉闭塞的疗效相当,但后者能够减少出血转化的发生,安全性更高。

Objective To observe the efficacy and safety of bridging therapy(BT)and direct mechanical thrombectomy(DMT)in the treatment of acute posterior circulation arterial occlusion.Methods The clinical data of 120 patients with acute posterior circulation great artery occlusion admitted to Haikou People’s Hospital from June 2020 to May 2023 were retrospectively analyzed.According to different treatment methods,62 patients treated with DMT were included in DMT group and 58 patients treated with BT were included in BT group.The treatment status,vascular recanalization rate,degree of neurological impairment(NIHSS score),Glasgow coma scale(GCS)score,good prognosis rate,the incidence rates of hemorrhagic transformation and symptomatic intracranial hemorrhage,and mortality rate were compared between the two groups.Results The vascular recanalization rate in BT group(84.48%)was higher than that in DMT group(80.65%),the difference was not statistically significant(P>0.05).On the 14th day after treatment,the NIHSS score(9.28±1.63)and the GCS score(12.57±2.60)of BT group had no statistically significant differences compared to the DMT group(8.93±1.50,13.15±2.87,respectively,P>0.05).The good prognosis rate in BT group(48.28%)during 90 days after treatment was higher than that in DMT group(41.94%),there was no difference between both groups(P>0.05).The incidence of postoperative hemorrhagic transformation in BT group(34.48%)was higher than that in DMT group(14.52%,P<0.05).There was no difference in symptomatic intracranial hemorrhage and 90-day mortality between the two groups(P>0.05).Conclusion The efficacy of BT and DMT in the treatment of acute post-circulation arterial occlusion is comparable,but the latter can reduce the occurrence of bleeding transformation and has higher safety.