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| 阶梯式血管内治疗策略在前循环急性颅内动脉粥样硬化性大血管闭塞患者中的应用效果 |
| 刘沛△,张磊△,花伟龙,张小曦,李子付,邢鹏飞,张永巍,杨鹏飞,洪波,刘建民* |
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(海军军医大学(第二军医大学)长海医院脑血管病中心, 上海 200433
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 探讨阶梯式血管内治疗策略对前循环颅内动脉粥样硬化性大血管闭塞（ICAS-LVO）相关急性缺血性脑卒中（AIS）的疗效和安全性。方法 回顾性分析2018年1月1日至2019年12月31日于我中心急诊行血管内治疗的前循环ICAS-LVO相关AIS患者的临床资料，所有患者均采用阶梯式血管内治疗策略。根据阶梯式治疗策略所采取的治疗方法，将患者分为单纯糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班输注组（GPI组）、GPI+球囊扩张术（BA）组和GPI+BA+支架成形术（RS）组。评价3组患者术后即刻血管成功再通（改良脑梗死溶栓分级≥2b级）率、术后症状性颅内出血发生率和术后90 d预后良好（改良Rankin量表评分≤2分）率、死亡率。结果 共有69例患者纳入研究，男53例、女16例，年龄为30~86岁，其中GPI组20例、GPI+BA组14例、GPI+BA+RS组35例。除既往缺血性脑卒中或短暂性脑缺血发作史和术前美国国立卫生研究院卒中量表评分外，其他基线资料如性别、年龄、高血压史、糖尿病史、冠心病史、吸烟史、饮酒史等在3组患者之间差异均无统计学意义（P均>0.05）。68例（98.6%）患者实现术后即刻血管成功再通。术后责任血管再闭塞率为6.7%（4/60），症状性颅内出血发生率为4.3%（3/69）。67例患者接受了术后90 d随访，2例失访，预后良好率为64.2%（43/67），死亡率为9.0%（6/67）。3组患者术后90 d预后良好率、死亡率和术后症状性颅内出血发生率、责任血管再闭塞率差异均无统计学意义（P均>0.05）。结论 对于ICAS-LVO相关AIS患者，采用阶梯式血管内治疗策略具有较好的安全性和疗效。 |
| 关键词: 急性缺血性脑卒中 血管内治疗 动脉粥样硬化性狭窄 大血管闭塞 阶梯式治疗 |
| DOI：10.16781/j.0258-879x.2022.01.0060 |
| 投稿时间：2021-09-18 |
| 基金项目:国家自然科学基金（82071278），上海申康医院发展中心临床研究关键支撑项目（SHDC2020CR6014） |
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| Application of step-by-step endovascular treatment strategy in patients with acute intracranial atherosclerosis-large vessel occlusion of anterior circulation |
| LIU Pei△,ZHANG Lei△,HUA Wei-long,ZHANG Xiao-xi,LI Zi-fu,XING Peng-fei,ZHANG Yong-wei,YANG Peng-fei,HONG Bo,LIU Jian-min* |
(Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To investigate the efficacy and safety of step-by-step endovascular treatment strategy for patients with acute ischemic stroke (AIS) caused by intracranial atherosclerosis-large vessel occlusion (ICAS-LVO) of anterior circulation.Methods The clinical data of patients with anterior circulation ICAS-LVO-related AIS who underwent emergency step-by-step endovascular treatment in our center from Jan. 1, 2018 to Dec. 31, 2019 were retrospectively analyzed. According to the step-by-step treatment methods, the patients were divided into glycoprotein Ⅱb/Ⅲa inhibitor (tirofiban) infusion group (GPI group), GPI+ballon angioplasty (BA) group and GPI+BA+rescue stenting (RS) group. The rate of successful recanalization (modified thrombolysis in cerebral infarction grade ≥ 2b) immediately after operation, incidence of symptomatic intracranial hemorrhage after operation, and good prognosis (modified Rankin scale score ≤ 2) rate and mortality 90 d after operation were evaluated.Results Totally 69 patients (53 males and 16 females), aged 30-86 years, were included in this study, including 20 patients in the GPI group, 14 in the GPI+BA group and 35 in the GPI+BA+RS group. There were no significant differences in baseline data, such as gender, age, hypertension, diabetes mellitus, coronary heart disease, smoking or drinking, among the 3 groups (all P>0.05), except for the history of ischemic stroke or transient ischemic attack and National Institutes of Health stroke scale score before operation. Sixty-eight (98.6%) patients had immediate successful recanalization. After operation, the reocclusion rate of responsible vessels was 6.7% (4/60), and the incidence of symptomatic intracranial hemorrhage was 4.3% (3/69). Sixty-seven patients were followed up 90 d after operation, and 2 were lost. The good prognosis rate was 64.2% (43/67), and the mortality was 9.0% (6/67). There were no significant differences in the 90 d good prognosis rate, 90 d mortality, incidence of symptomatic intracranial hemorrhage or reocclusion rate of responsible vessels among the 3 groups (all P>0.05).Conclusion For patients with AIS caused by ICAS-LVO, the step-by-step endovascular treatment strategy is safe and effective. |
| Key words: acute ischemic stroke endovascular treatment atherosclerotic stenosis large vessel occlusion step-by-step treatment |
