西藏地区20例静脉溶栓桥接动脉内取栓治疗急性颅内大血管闭塞效果分析

Effect Analysis of 20 Cases of Intravenous Thrombolysis Bridgeing Intraarterial Thrombectomy in the treatment of Acute Intracranial Large Vessel Occlusionin Xizang

目的 讨论在西藏地区行静脉溶栓桥接动脉内取栓治疗急性的颅内大血管闭塞患者方面的疗效。方法 回顾性分析了西藏自治区人民医院在2019年10月-2023年12月期间共20例急性颅内大动脉闭塞并采用静脉溶栓桥接动脉内取栓患者的临床资料。其中有5例患者为单纯大脑中动脉闭塞,有4例患者为基底动脉闭塞,有8例患者为颈内动脉闭塞,有3例患者为大脑中动脉合并颈内动脉闭塞。对年龄、民族、海拔、DNT(脑卒中患者到医院至开始溶栓的时间)、血管的再通时间、取栓次数、术后的血管再通效果、入院NIHSS(美国国立卫生卫生院卒中量表)评分、出院NIHSS评分、入院GCS(格拉斯哥昏迷评分法)评分和出院mRS(改良Rankin量表)评分进行分析。结果 在20例急性颅内动脉闭塞患者中,均成功开通闭塞血管,闭塞血管的血流达到eTICI分级2b50级,有4例患者在取栓术后出现出血转化并发症,给予二次开颅手术。根据90dmRS评分分为预后良好组(0~2分)和预后不良组(3~6分),预后良好组与预后不良组患者组间的性别、年龄、海拔DNT和血管的再通时间及取栓次数无明显的统计学意义(P>0.05)。在两组间的对比中,入院NIHSS评分、入院GCS、出院NIHSS评分有统计学意义(P<0.05)。结论 西藏地区静脉溶栓桥接动脉内取栓治疗急性颅内动脉闭塞的患者可获得良好的血管再通率(100%),治疗前循环血管闭塞的预后优于后循环血管闭塞的患者。

Objective The essay is to discuss the efficacy of intravenous thrombolytic bridging intra-arterial throm-bectomy in the treatment of patients with acute intracranial large vessel occlusion in the Tibetan Region.Methods A retrospective analysis was conducted on the clinical data of 20 patients with acute intracranial aortic occlusion and in-travenous thrombolysis bridging intra-arterial thrombectomy from October 2019 to December 2023 in People’s Hos-pital of Xizang Autonomous Region.Among the cases,5 patients had isolated middle cerebral artery(MCA)occlu-sion,4 patients had basilar artery occlusion,8 patients had internal carotid artery(ICA)occlusion,and 3 patients had MCA with ICA occlusion.Data analyzed included age,ethnicity,altitude,DNT(time from stroke onset to thromboly-sis),recanalizaiton time of blood vessels,number of thrombectomy,postoperative recanalization effect,admission NI-HSS(National Health Centers Stroke Scale)score,discharge NIHSS score,admission GCS(Glasgow Coma Scale)score,and discharge mRS(modified Rankin Scale)score.Results Among the 20 patients with acute intracranial ar-tery occlusion,all of them successfully opened the occluded blood vessels,and the blood flow of the occluded blood vessels reached the eTICI grade 2b50,and 4 patients had hemorrhagic transformation complications after thrombec-tomy and were given a second craniotomy.Based on 90-day mRS scores,patients were grouped into good prognosis(0~2 points)and poor prognosis(3~6 points)with no significant differences in gender,age,altitude,DNT,reperfusion time,or number of thrombectomy attempts(P>0.05).Statistically significant differences were observed in admission NIHSS,admission GCS,and discharge NIHSS scores between the groups(P<0.05).Conclusion Patients with intra-venous thrombolysis bridging intra-arterial thrombectomy in Xizang can achieve a good revascularization rate(100%),and the prognosis of pre-treatment circulation vascular occlusion is better than that of patients with posterior circulation vascular occlusions.