Endovascular treatment vs drug therapy alone in patients with mild ischemic stroke and large infarct cores

BACKGROUND Treatment decision making is strictly associated with the outcomes in patients with ischemic stroke who show a large core infarct.Medical care alone may result in suboptimal treatment efficacy,and endovascular treatment may be accompanied by safety issues.Whether endovascular treatment is superior to medical care is not well investigated in the clinical studies.AIM To investigate the efficacy of endovascular treatment and drug therapy alone in mild ischemic stroke patients with large infarct cores.METHODS Fifty patients with mild ischemic stroke and 50 patients with acute ischemic stroke caused by anterior large vessel occlusion were selected at the First Affiliated Hospital of Hebei North University between January 2021 and December 2021.Patients were divided into an endovascular therapy group and a drug therapy group according to different treatment methods.In the endovascular therapy group,there were 28 patients with minor stroke and 22 patients with large infarct cores.The drug therapy group had 22 patients with minor stroke and 28 patients with large infarct cores.The National Institutes of Health Stroke Scale(NIHSS) scores were collected and compared between the two groups immediately after the operation and 24 h and 7 d after the operation.The modified Rankin scale(m RS) and/or activity of daily living were assessed at hospital discharge.RESULTS There was no significant difference in NIHSS scores between the two groups before the operation(P > 0.05).NIHSS scores were lower in the endovascular therapy group than in the drug therapy group at 24 h and 7 d after the operation and at hospital discharge(all P < 0.05).The incidence of early neurologic deterioration was significantly lower in the endovascular therapy group than in the drug therapy group(P < 0.05).At hospital discharge,the m RS score was lower in the endovascular treatment group than in the drug therapy group,and the activity of daily living score was better in the endovascular treatment group than in the drug therapy group(all P < 0.05).During a follow-up of 3 mo,17 patients(34.0%) had good prognosis(m RS ≤ 2),33 patients(66.0%) had poor prognosis(m RS > 2),and 11 patients(22.0%) died.In the medical treatment group,16 patients(m RS ≤ 2) had good prognosis(32.0%),34 patients(m RS > 2) had poor prognosis(68.0%),and 14 patients(28.0%) died.There was no significant difference in prognosis and mortality between the two groups(P > 0.05).CONCLUSION Endovascular therapy can improve NIHSS score and m RS score in patients with mild ischemic stroke and large infarct cores.It is suitable for clinical application.

Electro-Acupuncture for Treatment of Dysequillibrium Due to Cerebellum or Brain Stem Infarction

The authors treated 26 cases of dysequillibrium due tocerebellum or brain stem infarction byelectro-acupuncture from Aug 2000 - April 2002. Theresults were quite satisfactory and reported as follows.

Blood–brain barrier and laser technology for drug brain delivery

Here,we discuss an important problem in medicine as development of efctive strategies for brain drug delivery.This problem is related to the blood-brain barrier(BBB),which is a“customs”controlling the entrance of different molecules from blood into the brain protecting the normal function of central nervous system(CNS).We show three interfaces of anatomical side of BBB and two functional types of BBB一physical and transporter barriers.Although this protective mechanism is essential for health of CNS,it also creates a hindrance to the entry of drugs into the brain.The BBB was discovered over 100 years ago but till now,there is no efective methods for brain drug delivery.There ane more than 70 approaches for overcoming BBB incuding physical,chenical and biological techniques but all of these tools have limitation to be widely used in clinical practice due to invasi venes,challenge in performing,very costly or lim-itation of drug concentration.Photodynamic therapy(PDT)is usual clinical method of surgical navigation for the resection of brain tumor and anti-cancer therapy.Nowadays,the application of PDT is considered as a potential promising tool for brain drug delivery via opening of BBB.Here,we show the first sucoessful experimental results in this field discussing the adventures and disadv antages of PDT-related BBB disruption as well as altematives to overcome these limitations and possi ble mechanisms with new pathways for brain clearance via gly mphatic and lymphatic systems.

Establishment of rabbit model of cerebral infarction for interventional treatment

AIM: To establish a model of cerebral infarction in order to study the interventional treatment.METHODS: An improved 3.0F SP Cobra catheter was introduced to the internal carotid artery by puncturing the femoral artery. After internal carotid arteriography thrombus was injected to embolize its MCA. 3 hours later, clinic observe and computed tomography was examined to analyze results.RESULTS: Clinic observation confirmed that the rabbit had some nerve defect symptoms and CT exam proved cerebral infarction.CONCLUSION: This technique is convenient for application and the model can meet the standard of study of clinical interventional treatment.

急性脑梗死患者溶栓后网膜素1水平对早期神经功能恶化的评估价值

目的探讨急性脑梗死患者溶栓后外周血网膜素1表达对早期神经功能恶化(early neurological deterioration,END)的评估价值。方法选取2021年2月至2022年2月郴州市第一人民医院神经内科明确诊断为急性脑梗死并行溶栓治疗的患者210例,根据溶栓后网膜素1水平分为低水平组70例(网膜素1<150μg/L),中水平组70例(150μg/L≤网膜素1≤200μg/L),高水平组70例(网膜素1>200μg/L),比较3组END发生情况。采用Pearson相关性分析网膜素1与END的相关性,用Cox回归分析发生END的影响因素,ROC曲线分析网膜素1对END的预测价值。结果210例急性脑梗死患者发生END 60例(28.6%)。低水平组、中水平组、高水平组END发生率比较,差异有统计学意义(45.7%vs 25.7%vs 14.3%,P<0.01),其中高水平组END发生率明显低于低水平组和中水平组,差异有统计学意义(P<0.01)。Pearson相关性分析显示,网膜素1与END发生呈负相关(r=-0.635,P<0.05)。多因素Cox回归分析显示,发病至溶栓时间、糖尿病、白细胞计数、网膜素1与急性脑梗死患者溶栓后发生END独立相关(P<0.05,P<0.01)。ROC曲线分析显示,网膜素1预测END发生的截断值为162.36μg/L,曲线下面积为0.868(95%CI:0.811~0.925),敏感性和特异性分别为73.3%、88.0%。结论急性脑梗死患者溶栓后外周血网膜素1水平与END的发生密切关联,网膜素1可作为评估END发生的生物标志物。

脑肠同调论针刺治疗急性脑梗死血清代谢组学研究

目的 分析脑肠同调论针刺治疗急性脑梗死的血清代谢组学的影响。方法 纳入2018年3月—2022年12月医院收治的急性脑梗死患者126例作为研究对象,随机数字表法分为两组,对照组63例采用常规疗法,观察组63例在此基础上采用脑肠同调论针刺治疗,对比两组治疗效果、神经功能,炎症因子水平以及对血清代谢组学的影响。结果 观察组总有效率为96.83%(61/63),远高于对照组的80.96%(57/63),神经功能缺损评分(NIHSS)评分低于对照组(P<0.05);治疗后观察组白介素-17(Interleukin-17,IL-17)、超敏C反应蛋白(hypersensitive C-reactive protein, hs-CRP)、血浆氧化三甲胺(trimethylamine oxide, TMAO)水平均低于对照组(P<0.05);治疗后观察组苯丙氨酸、溶血卵磷脂、焦谷氨酸水平低于对照组(P<0.05)。结论 脑肠同调论针刺治疗急性脑梗死效果明确,可减轻患者炎症反应,调节其肠道菌群代谢产物水平及氨基酸、磷脂代谢障碍等,使紊乱的代谢趋于正常,以达促进神经功能恢复,改善患者预后的目的,有较高应用价值。

Suppressing Wnt signaling of the blood-tumor barrier to intensify drug delivery and inhibit lipogenesis of brain metastases

Lipogenesis is often highly upregulated in breast cancer brain metastases to adapt to intracranial low lipid microenvironments.Lipase inhibitors hold therapeutic potential but their intra-tumoral distribution is often blocked by the blood-tumor barrier(BTB).BTB activates its Wnt signaling to maintain barrier properties,e.g.,Mfsd2a-mediated BTB low transcytosis.Here,we reported VCAM-1-targeting nano-wogonin(W@V-NPs)as an adjuvant of nano-orlistat(O@V-NPs)to intensify drug delivery and inhibit lipogenesis of brain metastases.W@V-NPs were proven to be able to inactivate BTB Wnt signaling,downregulate BTB Mfsd2a,accelerate BTB vesicular transport,and enhance tumor accumulation of O@V-NPs.With the ability to specifically kill cancer cells in a lipid-deprived environment with IC_(50) at 48 ng/mL,W@V-NPs plus O@V-NPs inhibited the progression of brain metastases with prolonged survival of model mice.The combination did not induce brain edema,cognitive impairment,and systemic toxicity in healthy mice.Targeting Wnt signaling could safely modulate the BTB to improve drug delivery and metabolic therapy against brain metastases.

获得性脑损伤患者多重耐药菌感染现状及其对脑功能的影响

目的调查获得性脑损伤康复住院患者多重耐药菌(MDRO)感染特征,并分析其对脑功能的影响。方法回顾性调查浙江省中医药大学附属第一医院2021年6月~2023年5月收治的获得性脑损伤康复住院患者334例,记录入院时多重耐药菌感染情况,将患者分为MDRO组96例和非MDRO组238例,并在入院和出院时通过格拉斯哥昏迷量表(GCS)、Barthel指数(BI)进行脑功能评估。结果96例MDRO组共采集到204份微生物标本,分别来源于痰液(152/204,74.5%)、尿液(46/204,22.5%)、伤口分泌物(6/204,2.9%),耐碳青霉烯肠杆菌科细菌(CRZ)为最主要MDRO类型,病原菌前三位是铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌。两组患者功能量表评分结果显示,MDRO组入院及出院时的功能障碍程度高于非MDRO组(P<0.01),且经过住院康复治疗后,两组出院时的GCS、Barthel指数均有改善(P<0.01)。结论28.7%的康复科获得性脑损伤患者在入院时存在多重耐药菌感染,主要来源于呼吸系统感染,最主要MDRO类型为CRE,其脑功能明显低于未感染患者,故今后在MDRO防控基础上,确保MDRO患者的康复治疗效果,以期改善患者的脑功能预后。

人造外泌体治疗心肌梗死:应用现状及前景

背景:心肌梗死是目前最严重的心血管疾病之一,现有的临床治疗方案如溶栓治疗、经皮冠状动脉介入治疗和冠状动脉旁路移植术均无法完全恢复缺血造成的心肌损伤。干细胞来源的外泌体治疗心肌梗死是近年来的研究热点,但天然来源的外泌体产量少,获取难度大、耗时长、归巢效果不佳等限制了其临床应用。在这种情况下,构建人造外泌体作为天然外泌体的替代品已成为解决上述问题的有效策略。目的:阐述人造外泌体在治疗心肌梗死中的研究现状,将其分为半人造和全人造两种设计模式,就两种模式的研究进展及存在的问题展开讨论,最后对其在未来的临床应用做出评价和展望。方法:以“人造外泌体,心肌梗死,工程化”为中文检索词,以“artificial exosome,hybrid exosome,myocardial infarction,nanoparticle,drug delivery system”为英文检索词,检索PubMed和中国知网数据库的相关文献。检索时限重点为2017年1月至2022年12月,同时纳入部分经典远期文献。通过阅读文题和摘要进行初步筛选;排除重复性研究、低质量期刊及内容不相关的文献,最后纳入73篇文献进行综述。结果与结论:(1)通过半人造改造外泌体的方式,不论是靶向肽段的修饰、生物膜的杂交或是磁力物质的辅助,均改善了传统的外泌体疗法靶向性不足、驻留率低、易被网状内皮系统所清除等缺陷,提高了传统外泌体治疗心肌梗死的效率,但是这些改造策略存在修饰效率不明确、医学伦理以及生物毒性等方面的问题。(2)全人造仿生外泌体相对于外泌体的改造,其设计自由度较高,可以解决天然来源外泌体提取存储难度高、规模化生产局限等问题,然而全人造外泌体的改造策略目前仍缺少可靠的临床前数据支持与生物安全性的检测,尚未形成规模化生产所需的标准化流程,因此在应用到临床以前,作为替代天然外泌体的人造外泌体方案仍需要科研人员进行持续深入研究。

脑梗死患者静脉溶栓疗程中VILIP-1、Annexin A2、sEPCR动态变化及与病情转归相关性

目的探讨脑梗死患者静脉溶栓疗程中视椎蛋白样蛋白1(visinin like protein-1,VILIP-1)、膜联蛋白A2(Annexin A2)、可溶性血管内皮蛋白C受体(solubleendothelium protein c receptor,sEPCR)动态变化及与病情转归相关性,为临床预测、改善患者预后提供参考。方法选取急性脑梗死患者105例进行前瞻性研究,均接受静脉溶栓治疗。以门诊方式随访28 d,根据患者病情转归情况分为良好组、不良组,检测2组溶栓前、溶栓后1 d、3 d的VILIP-1、Annexin A2、sEPCR水平,分析其与mRS评分的相关性,随机森林算法筛选特征变量,并分析病情转归的影响因素,分析不同时间点VILIP-1、Annexin A2、sEPCR及联合预测病情转归价值。结果不良组美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、D-二聚体、纤维蛋白原、三酰甘油高于良好组(P<0.05)。2组VILIP-1、sEPCR水平随着溶栓时间的延长而减低,Annexin A2随着溶栓时间的延长而升高(P<0.05);不良组VILIP-1、sEPCR和Annexin A2波动高于良好组(P<0.05)。溶栓后1 d、溶栓后3 d的VILIP-1、sEPCR与mRS评分呈正相关,Annexin A2与mRS评分呈负相关(P<0.05)。选取决策树数量ntree为390颗,得到最优结果,重要性排序前4的变量分别是sEPCR、Annexin A2、NIHSS评分、VILIP-1,均与mRS评分相关(P<0.05);溶栓后3 d三者联合的AUC最大,其预测敏感度为78.79%,特异度为95.83%。结论血清VILIP-1、Annexin A2、sEPCR异常表达与脑梗死患者脑损伤程度、溶栓预后有关,溶栓后3 d联合检测的预后价值较高,可作为脑梗死患者预后预测的重要标志物。

MECT联合药物治疗精神分裂症患者的效果及对血清BDNF、GFAP、PRL水平的影响

目的:探讨无抽搐电休克疗法(MECT)联合药物治疗精神分裂症患者的效果及对血清脑源性神经营养因子(BDNF)、胶质纤维酸性蛋白(GFAP)、催乳素(PRL)水平的影响。方法:纳入2021年1月—2023年5月江西省精神病院收治的82例精神分裂症患者,遵照随机数字表法将其分为观察组及对照组,各41例。对照组采用利培酮+奥氮平抗精神药物治疗方案,观察组在对照组基础上加用MECT干预。比较两组治疗前后精神状态[阳性与阴性症状量表(PANSS)]、认知状态[蒙特利尔认知评估量表(MoCA)]、记忆功能[韦氏记忆量表(WMS)]、执行功能[威斯康星卡片分类测验(WCST)]、血清指标(BDNF、GFAP、PRL)及不良反应发生情况。结果:治疗后,两组PANSS(阳性症状、阴性症状、一般精神病理评分)、WCST(错误应答数、首次分类应答数)、GFAP、PRL水平均较治疗前降低,且观察组水平均低于对照组,差异均有统计学意义(P<0.05)。治疗后,两组MoCA评分、WMS(再认、图片、联想、背数记忆评分)、WCST(完成分类数、正确应答数、概念水平百分数)及BDNF水平均较治疗前升高(P<0.05),且观察组水平均高于对照组,差异均有统计学意义(P<0.05)。两组不良反应比较,差异无统计学意义(P>0.05)。结论:采用MECT联合抗精神药物治疗效果确切,可明显改善患者精神症状、认知、记忆及执行等功能障碍,改善脑营养状态,且安全性良好。

2022~2023年神经重症进展与展望

在神经重症重点病种的临床诊疗方面,延长时间窗的取栓试验以及新的溶栓药物和溶栓方案的出现给缺血性卒中患者带来更大希望,微创血肿清除以及目标导向的集束化方案在治疗脑出血方面显示出令人惊喜的临床获益,重型颅脑损伤患者的去骨瓣治疗也涌现出高质量证据。在神经重症患者的重症管理方面,神经功能多模态监测、气道管理和呼吸治疗、抗癫痫管理方面也出现了一些高质量研究。在2022~2023年,动脉瘤性蛛网膜下腔出血指南和自发性脑出血指南进行了更新,神经重症患者镇痛镇静治疗和营养治疗也推出了中国专家共识。总体而言,神经重症领域取得可喜进展,但未来仍需更多高质量大样本的研究来加以完善,以指导精准化、个性化治疗。

欧洲医药保健网分类系统用于脑梗死患者药物治疗管理实践

目的探讨临床药师在药物治疗管理(MTM)中基于欧洲医药保健网(PCNE)分类系统识别脑梗死患者药物相关问题(DRP)的作用,以及对干预效果的影响。方法选取医院2022年6月至9月收治的脑梗死住院患者80例,按随机数字表法分为对照组和干预组,各40例。对照组患者给予传统治疗模式;干预组患者在对照组基础上开展MTM,采用PCNE分类系统识别DRP,分析DRPs的问题类型和原因类型,提供介入方案,并了解医师和患者对介入方案的接受情况及DRP的解决状态。两组患者均随访至出院后1个月。结果干预组中,共发现DRP 45例次,其中治疗效果问题21例次(46.67%),治疗安全性问题14例次(31.11%),其他问题10例次(22.22%);DRP原因47例次,其中药物选择相关原因26例次(55.32%),剂量选择相关原因12例次(25.53%),患者相关原因7例次(14.89%),治疗疗程相关原因2例次(4.26%);医师和患者完全接受介入方案35例次(77.78%),DRP全部解决37例次(82.22%)。与治疗前比较,干预组患者出院时与出院1个月后的中医证候积分均明显降低(P<0.05),且明显低于对照组(P<0.05);干预组患者出院时Morisky药物依从性量表评分明显升高(P<0.05),且明显高于对照组(P<0.05);两组患者出院时及出院1个月后的美国国立卫生研究院卒中量表评分均明显降低(P<0.05)。结论临床药师对脑梗死患者实施MTM和PCNE分类系统的药学监护,可识别并解决DRPs,改善患者中医证候和病情严重程度,提高患者用药依从性,且医师接受程度高。

Tall gastrodis tuber combined with antiepileptic drugs repairs abnormal perfusion foci in focal epilepsy

One hundred patients with focal epilepsy were recruited for the present study and their seizures controlled with antiepileptic drugs. The patients then orally received a capsule of tall gastrodis tuber powder, a traditional Chinese drug, and underwent single photon emission computed tomography, long-term electroencephalogram, and CT/MRI. Blood drug levels were monitored throughout the study. Before treatment with tall gastrodis tuber, 35 of the 100 cases had abnormal CT/MRI scans; 79 cases had abnormal single photon emission computed tomography images; 86 cases had abnormal electroencephalogram; and a total of 146 abnormal perfusion foci were observed across the 100 subjects. After treatment, the number of patients with normal single photon emission computed tomography images increased by 12; normal electroencephalogram was observed in an additional 27 cases and the number of patients with epileptiform discharge decreased by 29 （34% of 86）; the total number of abnormal perfusion foci decreased by 52 （36%） and changes in abnormal loci were visible in 65 patients. These changes indicate that the administration of tall gastrodis tuber in combination with antiepileptic drugs repairs abnormal perfusion foci in patients with focal epilepsy Our results demonstrate that traditional Chinese drugs can repair abnormal perfusion foci and, as such, are a promising new pathway in the treatment of focal epilepsy.

Brain natriuretic peptide and optimal management of heart failure

Aside from the important role of brain natriuretic peptide (BNP) in diagnosis, and differential diagnosis of heart failure, this biological peptide has proved to be an independent surrogate marker of rehospitalization and death of the fatal disease. Several randomized clinical trials demonstrated that drugs such as beta blocker, angiotensin converting enzyme inhibitor, spiro- nolactone and amiodarone have beneficial effects in decreasing circulating BNP level during the management of chronic heart failure. The optimization of clinical decision-making appeals for a representative surrogate marker for heart failure prognosis. The serial point-of-care assessments of BNP concentration provide a therapeutic goal of clinical multi-therapy and an objective guid- ance for optimal treatment of heart failure. Nevertheless new questions and problems in this area remain to be clarified. On the basis of current research advances, this article gives an overview of BNP peptide and its property and role in the management of heart failure.

Neuroprotective effects of the immunomodulatory drug Setarud on cerebral ischemia in male rats

immunomodulary drug Setarud, which is composed of herbal extracts including Rosa canina, Urtica dioica and Tanacetum vulgare, supplemented with selenium exhibits anti-inflammatory and anti-oxidant properties. Therefore, we hypothesized that Setarud will have a neuroprotective effect against ischemic cerebral injury. To validate this hypothesis, rats were intraperitoneally administered with 0.66 mL/kg Setarud for 30 minutes after middle cerebral artery occlusion. Triphenyltetrazolium chloride staining showed that Setarud could reduce cerebral infarct volume of rats subjected to cerebral ischemia. Transmission electron microscopy and hematoxylin-eosin staining results showed that Setarud could alleviate the degenerative changes in cortical neurons of rats with cerebral ischemia. The inclined plate test and prehensile test showed that Setarud could significantly improve the motor function of rats with cerebral ischemia. These findings suggest that Setarud shows neuroprotective effects against ischemic brain injury.

Gene therapy with caspase-3 small interfering RNA-nanoparticles is neuroprotective after optic nerve damage

Apoptosis,a key mechanism of programmed cell death,is triggered by caspase-3 protein and lowering its levels with gene therapy may rescue cell death after central nervous system damage.We developed a novel,non-viral gene therapy to block caspase-3 gene expression using small interfering RNA(siRNA)delivered by polybutylcyanoacrylate nanoparticles(CaspNPs).In vitro CaspNPs significantly blocked caspase-3 protein expression in C6 cells,and when injected intraocularly in vivo,CaspNPs lowered retinal capsase-3 immunofluorescence by 57.9%in rats with optic nerve crush.Longitudinal,repeated retinal ganglion cell counts using confocal neuroimaging showed that post-traumatic cell loss after intraocular CaspNPs injection was only 36.1%versus 63.4%in lesioned controls.Because non-viral gene therapy with siRNA-nanoparticles can selectively silence caspace-3 gene expression and block apoptosis in post-mitotic neurons,siRNA delivery with nanoparticles may be promising for neuroprotection or restoration of central visual system damage and other neurological disorders.The animal study procedures were approved by the German National Act on the use of experimental animals(Ethic Committee Referat Verbraucherschutz,Veterinärangelegenheiten;Landesverwaltungsamt Sachsen-Anhalt,Halle,Germany,#IMP/G/01-1150/12 and#IMP/G/01-1469/17).

Brainstem abscesses caused by Listeria monocytogenes:A case report

BACKGROUNDIntracranial Listeria infections are common in newborns and immunocompromisedindividuals, but brainstem abscesses are rare.CASE SUMMARYWe report a rare case of brainstem abscesses caused by Listeria monocytogenes in apreviously healthy adult patient. The patient’s magnetic resonance imagingexamination showed multiple brain abscesses, and his second cerebrospinal fluidculture test indicated the presence of Listeria monocytogenes. Despite earlyempirical therapy, the patient’s condition progressively deteriorated. Because thepatient's abscesses were located in the brainstem and multiple lobes, surgery wasnot possible. The patient died 40 d after admission.CONCLUSIONThis case highlights the importance of rational clinical use of drugs to avoidpotentially serious infectious complications.

In-Stent Thrombosis after Antiplatelet Therapy Conversion while Awaiting Coronary Bypass

In-stent thrombosis(IST)is a rare yet dangerous complication that may occur despite optimized coronary intervention in the cardiac catheterization laboratory.This is a case of an 81-year-old man who presented with ST-elevation myocardial infarction.Right coronary artery(RCA)occlusion was suspected.RCA angiography and percutaneous coronary intervention were performed.Complicated left coronary artery disease was subsequently discovered.Per cardiothoracic surgeon request,the patient was transitioned from ticagrelor to clopidogrel therapy in preparation for coronary artery bypass grafting.The patient experienced IST the day before surgery while receiving clopidogrel.We examine this case,which highlights the complexity of antiplatelet therapy choice and the role of genetic testing in evaluation of IST risk.

不同取栓方式治疗急性大脑中动脉M2段闭塞性脑梗死的疗效及安全性

目的:探讨不同取栓方式用于治疗急性大脑中动脉M2段闭塞性脑梗死的疗效及安全性。方法:回顾性分析2018年8月至2022年10月丽水市中心医院接受机械取栓治疗的45例大脑中动脉M2段闭塞性脑梗死患者临床资料,分为直接抽吸组和抽吸结合支架取栓组(简称联合组),分析两组取栓次数、血管再通时间、治疗有效率、良好预后率的差异。结果:联合组平均股动脉穿刺-再通时间为(61.7±17.4)min,比直接抽吸组的(71.3±24.2)min短,差异有统计学意义(P=0.037);联合组取栓次数少于直接抽吸组,差异有统计学意义[1.0(1.0,2.0)vs.2.0(1.0,4.0),P=0.034];联合组治疗有效率为77.8%,直接抽吸组为55.6%;联合组良好预后率为70.4%,直接抽吸组为44.4%。结论:急性大脑中动脉M2段闭塞性脑梗死患者,抽吸联合支架取栓术与直接抽吸取栓术相比,再通时间更短,有效率及良好预后率可能更高。