摘要
目的对比分析大动脉粥样硬化与单纯性动脉栓塞致前循环大血管闭塞血管内治疗的临床结局。方法纳入2020年8月至2022年9月蚌埠医科大学第二附属医院收治的87例急性前循环大血管闭塞患者,均行血管内治疗,包括静脉溶栓、支架取栓术、抽吸取栓术或血管成形术(球囊扩张术或支架植入术),根据术中所见(病因)分为大动脉粥样硬化组(LAA组,32例)和单纯性动脉栓塞组(栓塞组,55例)。主要结局指标为术后90d神经功能预后[改良Rankin量表(mRS)],次要结局为术后血管再通率[改良脑梗死溶栓血流分级(mTICI)]和术后1d症状性脑出血发生率。结果栓塞组患者房颤(χ^(2)=17.672,P=0.000)和取栓次数≥3次(χ^(2)=10.606,P=0.001)比例高于LAA组,静脉溶栓比例低于LAA组(χ^(2)=5.403,P=0.020),而两组发病至手术时间(Z=1.111,P=0.267)、入院至手术时间(Z=0.149,P=0.882)、血管内治疗首选术式(Fisher确切概率法:P=0.153),以及主要结局术后90d神经功能预后良好(mRS评分≤2分)率(χ^(2)=0.004,P=0.950)和病死率(χ^(2)=0.035,P=0.851)、次要结局术后血管再通(mTICI分级≥Ⅱb级)率(χ^(2)=0.033,P=0.856)和术后1d症状性脑出血发生率(χ^(2)=0.345,P=0.557)差异均无统计学意义。结论大动脉粥样硬化与单纯性动脉栓塞致前循环大血管闭塞血管内治疗效果和临床预后相当。
Objective To compare and analyze the clinicaloutcomes ofendovascular treatment of anterior circulation large vessel occlusion(ac-LVO)caused by large artery atherosclerosis(LAA)andsimple arterial embolization.Methods From August 2020 to September 2022,87 patients with ac-LVO hospitalized in The Second Affiliated Hospital of Bengbu Medical University were enrolled.All patients were treated with endovascular treatment,including intravenous thrombolysis,stent thrombectomy,aspiration thrombectomy or angioplasty(balloon dilatation or stent implantation).According to intraoperative findings(etiology),they were divided into LAA group(n=32)and simple arterial embolization group(embolization group,n=55).The primary outcome wasthe 90d modified Rankin Scale(mRS)score,and the secondary outcomes were postoperative vascular recanalization rate[modified Thrombolysis Cerebral Infarction(mTICI)]and incidence of symptomatic cerebral hemorrhage 1d after surgery.Results The proportions of patients with atrial fibrillation(χ^(2)=17.672,P=0.000)and thrombus retrieval≥3 times(χ^(2)=10.606,P=0.001)in the embolization group were higher than those in the LAA group,the proportion of intravenous thrombolysis in the embolization group was less than that in the LAA group(χ^(2)=5.403,P=0.020).However,thetimefrom onset to operation(Z=1.111,P=0.267),the time from admission to operation(Z=0.149,P=0.882),preferred surgical approach for endovascular treatment(Fisher's exact probability:P=0.153),as well as the rate of good prognosis(mRSscore≤2;χ^(2)=0.004,P=0.950)andmortality(χ^(2)=0.035,P=0.851)at 90d after surgery,the rate of postoperative vascularrecanalization(mTICIgrade≥Ⅱb;χ^(2)=0.033,P=0.856)and symptomatic cerebral hemorrhage rate 1d after surgery(χ^(2)=0.345,P=0.557)forthe secondary outcome were observed in both groups,the above differences were not statistically significant.Conclusions The efficacy and prognosis of endovascular treatment of ac-LVO caused by LAA and simple arterial embolization has the same effect and clinical prognosis.
作者
周星辰
赵彪
王大巍
张辉
王昊
闵敬亮
ZHOU Xing-chen;ZHAO Biao;WANG Da-wei;ZHANG Hui;WANG Hao;MIN Jing-liang(Department of Neurosurgery,The Second Affiliated Hospital of Bengbu Medical University,Bengbu 233000,Anhui,China)
出处
《中国现代神经疾病杂志》
CAS
北大核心
2024年第9期758-764,共7页
Chinese Journal of Contemporary Neurology and Neurosurgery
基金
安徽省高等学校自然科学研究重点项目(项目编号:2023AH052015)。
关键词
动脉闭塞性疾病
脑动脉疾病
支架
球囊和椭圆囊
血栓切除术
脑血管造影术
Arterial occlusive diseases
Cerebral arterial diseases
Stents
Saccule and utricle
Thrombectomy
Cerebralangiography
作者简介
通讯作者:周星辰,Email:492569992@qq.com。
