摘要
【目的】探讨经微导管机械碎栓和支架取栓两种方法结合动脉内溶栓治疗急性脑动脉闭塞的疗效及安全性。【方法】回顾性收集2010年5月至2013年12月共82例急性脑动脉闭塞患者。其中58例病人在发病后3～5 h行微导管机械碎栓治疗,24例病人行Solitaire AB支架取栓治疗。两组病人均联合应用尿激酶溶栓治疗,其血流动力学评估采用前向血流评定TICI分级。当前向血流达TICIⅡ-Ⅲ级时表示血管再通成功,TICI 0-Ⅰ级表示血管再通失败。脑卒中严重程度评估采用美国国立卫生研究院卒中量表评分。我们分别统计及比较两组患者术前和术后3天NIHSS评分、术后血管再通率及并发症发生率。【结果】碎栓组血管再通成功47例,再通失败11例,血管再通率81.0%,继发性脑出血2例(3.45%),再通后血栓脱落导致继发性脑栓塞2例(3.45%),术后3天患者NIHSS评分较术前降低,差异有统计学意义(P<0.001);取栓组血管再通成功20例,再通失败4例,血管再通率83.3%,继发性脑栓塞1例,无颅内出血并发症,术后3天患者NIHSS评分较术前降低,差异有统计学意义(P<0.001);两组患者血管再通率比较差异无统计学意义(P>0.05)。【结论】支架取栓术的临床疗效和安全性值得肯定,而碎栓组血管再通成功率不低于取栓组,相比之下,碎栓技术更容易推广应用,临床上应根据具体情况选择合适的治疗方法。
[Objective] To explore the safety and efficacy of mechanical thrombectomy by catheter and embolectomy by-stents combined with intra-arterial thrombolysis in the treatment of acute cerebral artery occlusion.[Method] 82 patients with acute cerebral arterial occlusion were retrospectively collected from May 2010 to December 2013.58 patients within 3-5 hours were treated by mechanical thrombectomy through catheter and 24 patients were treated by Solitaire AB stent.The patients in both groups were treated with urokinase thrombolysis and the hemodynamic status for each patient was evaluated using the thrombolysis in cerebral ischemia grade （TICI）.TICI level Ⅱ-Ⅲ of the forward blood flow represent the success of recanalization and and TICI level 0 to Ⅰ stand for failure.The assessment of National Institutes of Health Stroke Scale （NIHSS） was performed to evaluate the severity of the stroke.The score of the NIHSS,the rate of revascularization and the rate of postoperative complications for each patient in each group was recorded respectively before the operation and there days after the operation and was compared between the two groups.[Result] In the group treated with mechanical thrombectomy,47 cases succeeded in recanalization and 11 cases failed,the revascularization rate was 81.0％.Secondary cerebral hemorrhage occurred in 2 case （3.45％）.Secondary cerebral embolism after revascularization occurred in 2 cases （3.45％）.The assessment of NIHSS after the operation showed significantly lower scores （P ＜ 0.001） compared with the NIHSS scores before the operation.In the group treated with embolectomy,20 cases succeeded in recanalization and 4 cases failed and the revascularization rate was 83.3％.Secondary cerebral embolism occurred in 1 case and there is no one with Secondary cerebral hemorrhage.The assessment of NIHSS after the operation also showed significantly lower scores （P ＜ 0.001） compared with the NIHSS scores before the operation.The revascularization rate showed no significant difference （P ＞ 0.05） before the operation and there days after the operation.[Conclusion] Although the efficacy and safety of embolectomy is deserved to affirm,the rate of revascularization in the group treated with mechanical thrombectomy was not lower than the group treated with embolectomy.According to our study,mechanical thrombectomy is easier topopularize and apply in the clinic and in practicewe should choose the appropriate treatment according to different situations.
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2014年第3期445-451,共7页
Journal of Sun Yat-Sen University:Medical Sciences
关键词
机械碎栓
支架取栓
动脉内溶栓
急性缺血性脑卒中(AIS)
脑动脉闭塞
mechanical thrombectomy
embolectomy
intra-arterial thrombolysis
acute ischemic stroke （AIS）
cerebral artery occlusion
