支架联合中间导管取栓治疗急性基底动脉闭塞性脑梗死疗效观察

Effect of stent-assisted thrombectomy combined with intermediate catheter aspiration in the treatment of acute basilar artery occlusive cerebral infarction

目的探讨支架联合中间导管取栓治疗急性基底动脉闭塞性脑梗死的临床疗效。方法选择2022年7月至2023年7月沧州市人民医院神经内科收治的80例急性基底动脉闭塞性脑梗死取栓患者为研究对象,按照治疗方法将患者分为采用支架取栓的对照组和采用支架联合中间导管取栓的观察组,每组40例。采用美国国立卫生研究院卒中量表(NIHSS)评估2组患者干预前后神经功能缺损情况;采用改良脑梗死溶栓分级(mTICI)评估患者的血管再通情况;治疗后3个月采用改良Rankin量表(mRS)评估患者的临床预后,其中mRS评分≤2分表示预后良好,mRS评分>2分表示预后不良;术后随访12个月,观察患者的并发症发生情况及病死率。结果2组患者治疗前NIHSS评分比较差异无统计学意义(P>0.05);2组患者治疗后24 h和治疗后3个月的NIHSS评分均显著低于治疗前(P<0.01);观察组患者治疗后24 h和治疗后3个月的NIHSS评分均显著低于对照组(P<0.01)。对照组患者mTICI评分为2b级和3级者共22例,对照组患者的血管首次再通率为55.0%(22/40);观察组患者的mTICI评分2b级和3级者共35例,观察组患者的血管首次再通率为87.5%(35/40);观察组患者的血管首次再通率显著高于对照组(χ^(2)=10.313,P<0.01)。治疗后3个月,对照组患者mRS评分为0~2分者13例,对照组患者的预后良好率为32.5%(13/40);观察组患者mRS评分为0~2分者21例,观察组患者的预后良好率为52.5%(21/40);观察组患者的预后良好率显著高于对照组(χ^(2)=6.619,P<0.05)。术后随访12个月,对照组患者发生卒中相关肺炎18例(45.0%)、脑疝5例(12.5%)、症状性颅内出血4例(10.0%),死亡12例(30.0%);观察组患者发生卒中相关肺炎10例(25.0%)、脑疝4例(10.0%)、症状性颅内出血2例(5.0%),死亡8例(12.0%);观察组与对照组患者脑疝、症状性颅内出血的发生率比较差异无统计学意义(χ^(2)=0.125、0.721,P>0.05);观察组患者卒中相关肺炎发生率及病死率显著低于对照组(χ^(2)=4.016、3.954,P<0.05)。结论支架联合中间导管取栓能更好地提高急性基底动脉闭塞性脑梗死患者的首次再通率,改善患者的神经功能和预后。

Objective To explore the clinical efficacy of stent-assisted thrombectomy combined with intermediate catheter aspiration in the treatment of acute basilar artery occlusive cerebral infarction.Methods Eighty patients with acute basilar artery occlusive cerebral infarction admitted to the Department of Neurology of Cangzhou People′s Hospital from July 2022 to July 2023 were selected as the research subjects.The patients were divided into the control group(stent-assisted thrombectomy)and the observation group(stent-assisted thrombectomy combined with intermediate catheter aspiration)according to the treatment method,with 40 patients in each group.The neurological deficit of the patients in both groups was evaluated by using the National Institutes of Health Stroke Scale(NIHSS)before and after the intervention;the vascular recanalization of the patients was evaluated by using the modified thrombolysis in cerebral infarction(mTICI)grade;and the clinical prognosis of the patients was assessed by using the modified Rankin scale(mRS)at 3 months after treatment(mRS score≤2:favorable prognosis;mRS score>2:poor prognosis).A 12-month postoperative follow-up was conducted to monitor the incidence of complications and the mortality rate.Results There was no significant difference in the NIHSS score of patients between the two groups before treatment(P>0.05);the NIHSS scores of patients in both groups at 24 hours and 3 months after treatment were significantly lower than those before treatment(P<0.01);the NIHSS scores of patients in the observation group at 24 hours and 3 months after treatment were significantly lower than those in the control group(P<0.01).There were a total of 22 patients with mTICI grades of 2b and 3 in the control group,and the first vascular recanalization rate was 55.0%(22/40);there were a total of 35 patients with mTICI grades of 2b and 3 in the observation group,and the first vascular recanalization rate was 87.5%(35/40);and the first vascular recanalization rate of patients in the observation group was significantly higher than that in the control group(χ^(2)=0.375,P>0.05).Three months after treatment,there were 13 patients in the control group with an mRS score of 0 to 2,and the favorable prognosis rate was 32.5%(13/40);there were 21 patients in the observation group with an mRS score of 0 to 2,and the favorable prognosis rate was 52.5%(21/40);the favorable prognosis rate of patients in the observation group was significantly higher than that in the control group(χ^(2)=6.619,P<0.05).During the 12-month follow-up,stroke-associated pneumonia occurred in 18 patients(45.0%),cerebral hernia occurred in 5 patients(12.5%),symptomatic intracranial hemorrhage occurred in 4 patients(10.0%),and 12 patients died,with a fatality rate of 30.0%in the control group;while in the observation group,stroke-associated pneumonia occurred in 10 patients(25.0%),cerebral hernia occurred in 4 patients(10.0%),symptomatic intracranial hemorrhage hemorrhage occurred in 2 patients(5.0%),and 8 patients died,with a fatality rate of 12.0%.There was no significant difference in the incidence of cerebral hernia and symptomatic intracranial hemorrhage between the observation group and control group(χ^(2)=0.125,0.721;P>0.05).The incidence of stroke-associated pneumonia and the fatality rate of patients in the observation group were significantly lower than those in the control group(χ^(2)=4.016,3.954;P<0.05).Conclusion Stent-assisted thrombectomy combined with intermediate catheter aspiration can effectively improve the first recanalization rate and enhance the neurological function and prognosis of patients with acute basilar artery occlusive cerebral infarction.