分水岭脑梗死患者血管内治疗的长期疗效观察

Long-term efficacy of endovascular treatment in patients with watershed cerebral infarction

目的探讨血管内介入治疗及药物治疗对伴责任动脉严重狭窄分水岭脑梗死患者的近期及远期疗效。方法回顾性分析195例急性分水岭脑梗死(cerebral watershed infarction,CWI),根据干预措施不同,患者被分为介入治疗组(87例)及药物治疗组(108例)。介入治疗组于发病2 w内行颈内动脉或大脑中动脉M1段介入治疗,同时给予抗血小板、他汀等药物治疗;药物治疗组单纯给予抗血小板、他汀等治疗。通过电话随访,比较出院后3 m、6 m及1 y两组的NIHSS评分及3 m、6 m、1 y、2 y及5 y的mRS评分及随访期间的脑出血、脑梗死、TIA及死亡的发生情况。结果 (1)两组患者在出院后3 m的NIHSS评分下降明显不同(P=0. 008);(2)介入治疗组患者治疗后3 m、6 m、5 y及随访终止时间mRS≤2患者的比例明显高于药物治疗组(P分别为0. 037、0. 035、0. 035及0. 022);(3)血管内介入治疗组出院至1 y、2 y、5 y及随访终止时责任血管同侧缺血性卒中的复发率明显低于药物治疗组(P分别为0. 049、0. 049、0. 03及0. 017);(4)两组患者随访期间总死亡率及死于脑梗死的比例均无差异(P分别为0. 723、0. 505)。结论对CWI患者,与单纯药物治疗比较,早期血管内介入治疗能明显促进神经功能恢复,减少残疾,改善患者预后;且能预防远期脑梗死及短暂性脑缺血发作的复发率。

Objective To investigate the short-term and long-term effects of endovascular interventional therapy and drug therapy on cerebral watershed infarction with severe stenosis of the responsible artery. Methods We retrospectively analyzed 195 cases of cerebral watershed infarction( CWI). According to different treatments,patients were divided into interventional treatment group( 87 cases) and drug treatment group( 108 cases). In the interventional group,patients were treated with interventional therapy in the intracranial artery or middle cerebral artery M1 segment within 2 weeks of oneset,also were given antiplatelet and statin drugs;while the patients in the drug treatment group was only given antiplatelet and statin. Follow-up by telephone,we compared the NIHSS scores at 3 months,6 months,and 1 year as well as mRS at 3 months,6 months,1 year,2 years,and 5 years after discharge between the two groups. Besides,we compared the occurrences of cerebral hemorrhage,cerebral infarction,TIA,and death during the follow-up period. Results( 1) The decline of NIHSS scores was significantly different between the two groups at 3 months after discharge( P = 0. 008);( 2) The proportion of patients with mRS ≤ 2 was significantly higher of the interventional group than the drug-treated group at 3 months,6 months,5 years and at the end of follow-up after discharge( P = 0. 037,0. 035,0. 035,and 0. 022,respectively);( 3) The recurrence rate of ipsilateral ischemic stroke of the endovascular intervention group was significantly lower than the drugtreated group at 1 year,2 years,5 years,and at the end of follow-up after discharge( P = 0. 049,0. 049,0. 03,and 0. 017,respectively);( 4) There was no difference in the total mortality and the proportion of patients who died of cerebral infarction between two groups during the follow-up period( P = 0. 723,0. 505,respectively). Conclusion For cerebral watershed infarction patients,compared with drug therapy alone,early endovascular intervention could significantly promote the recovery of neurological function,reduce disability,improve the prognosis of patients,and prevent the recurrence rate of long-term cerebral infarction and transient ischemic attack.