机械取栓治疗急性缺血性脑卒中单中心研究

doi:10.19723/j.issn.1671-167X.2019.02.010

摘要/Abstract

摘要：

目的: 评估支架机械取栓治疗急性缺血性脑卒中(acute ischemic stroke,AIS)的有效性和安全性,并初步探讨其临床预后的影响因素。方法: 回顾性分析2014年1月至2017年6月北京大学第三医院采用支架机械取栓治疗的26例AIS患者资料,分析即时取栓效果,对比患者术前及出院时美国国立卫生研究院卒中量表评分(national institutes of health stroke scale,NIHSS),并分析术后90 d随访时改良Rankin量表评分(modified Rankin scale,mRS),评估患者预后。结果: (1)26例进行支架机械取栓的AIS患者中23例(88.5%)成功获得血管再通,采用脑梗死溶栓分级评分(thrombolysis in cerebral ischemia scale,TICI)进行评估,达到3级或2b级为血管再通;26例患者中3例(11.5%)发生症状性颅内出血,4例(15.4%)出现临床死亡。(2)出院时NIHSS评分比术前明显降低,差异有统计学意义(P<0.01),术后90 d有12例患者(46.2%)达到良好临床预后(mRS 0~2分)。结论: 使用支架机械取栓治疗急性脑动脉闭塞导致的AIS可获得较高的再通率,改善临床预后,但部分病例预后差,提示应更加严格地筛选患者进行治疗。

关键词: 机械取栓, 急性缺血性脑卒中, 支架

Abstract:

Objective: To evaluate the effectiveness and safety of mechanical thrombectomy treatment in patients with acute ischemic stroke (AIS),and to explore influential factors of the clinical prognosis preliminarily.Methods: Clinical data of 26 patients with acute cerebral arterial occlusion treated with mechanical thrombectomy in Peking University Third Hospital from January 2014 to June 2017 were retrospectively collected. The immediate effects of the 26 patients in this group after mechanical thrombectomy treatment were analyzed,The national institutes of health stroke scale (NIHSS) scores between preoperative and at discharge of the 26 patients in this group were compared,and modified Rankin scale (mRS) scores of 90 days post operation were analyzed to assess the prognosis of the 26 patients in this group.Results: (1)In this group, 23 patients (88.5%) achieved vascular recanalization evaluated by thrombolysis in cerebral ischemia scale scores [thrombolysis in cerebral ischemia scale (TICI) scores,3/2b grades were recognized as vascular recanalization],19 patients of them reached TICI grade 3 and 4 atients reached TICI grade 2b. In this group 3 patients (11.5%)encountered symptomatic intracranial hemorrhage,2 patients of them recovered after cerebral hemorrhage absorbed and 1 patient died of massive cerebral hemorrhage. In this group 4 patients (15.4%) died after mechanical thrombectomy treatment,2 patients died of hernia of the brain caused by severe cerebral edema,1 patient died of symptomatic intracranial hemorrhage and 1 patient died of extensive subarachnoid hemorrhage.(2)The assessment of NIHSS scores at discharge(5.3±2.1)showed significantly lower than those preoperatively(12.6±4.2), P<0.01,and in this group 12 patients (46.2%) achieved favourable prognosis ( defined as mRS scores 0-2),6 patients of them reached mRS 0 score,4 patients reached mRS 1 score and 2 patients reached mRS 2 scores.Conclusion: Mechanical thrombectomy with stent retriever contributed to a high rate of vascular recanalization and favourable prognosis,but some patients had poor prognosis,suggesting that we should screen the enrolled patients strictly.

Key words: Mechanical thrombectomy, Acute ischemic stroke, Stent

中图分类号:

R654.4

贾子昌,李选,李小刚,曾祥柱,栾景源,王昌明,韩金涛. 机械取栓治疗急性缺血性脑卒中单中心研究[J]. 北京大学学报（医学版）, 2019, 51(2): 256-259.

Zi-chang JIA,Xuan LI,Xiao-gang LI,Xiang-zhu ZENG,Jing-yuan LUAN,Chang-ming WANG,Jin-tao HAN. Mechanical thrombectomy treatment in patients with acute ischemic stroke: a single center study[J]. Journal of Peking University(Health Sciences), 2019, 51(2): 256-259.

图/表 6

表1

图1

图2

图3

图4

表2

26例患者临床治疗效果及安全性结果"

Clinical outcomes	Statistics
Vascular recanalization (TICI 2b or 3 grade), n(%)	23(88.5)
NIHSS score (postoperative), $x ?$ ±s	5.3±2.1
mRS score(0-2) at 90 d, n(%)	12(46.2)
Stroke-ralated death at 90 d, n(%)	3(11.5)
Death from any cause at 90 d, n(%)	4(15.4)
Symptomatic intracranial hemorrhage at 24 h, n(%)	3(11.5)
Neurologic deterioration at 24 h, n(%)	5(19.2)

表2

参考文献 12

[1]	王陇德 . 中国脑卒中防治报告2015 [M]. 北京: 中国协和医科大学出版社, 2015: 9-64.
[2]	Berkhemer OA, Fransen PS, Beumer D , et al. A randomized trial of intraarterial treatment for acute ischemic stroke[J]. N Engl J Med, 2015,372(1):11-20. doi: 10.1056/NEJMoa1411587
[3]	Goyal M, Demchuk AM, Menon BK , et al. Randomized assessment of rapid endovascular treatment of ischemic stroke[J]. N Engl J Med, 2015,372(11):1019-1030. doi: 10.1056/NEJMoa1414905
[4]	Campbell BC, Mitchell PJ, Kleinig TJ , et al. Endovascular therapy for ischemic stroke with perfusion imaging selection[J]. N Engl J Med, 2015,372(11):1009-1018. doi: 10.1056/NEJMoa1414792
[5]	Saver JL, Goyal M, Bonafe A , et al. Stent-retriever thrombectomy after intravenous t-PA vs t-PA alone in stroke[J]. N Engl J Med, 2015,372(24):2285-2295. doi: 10.1056/NEJMoa1415061
[6]	Jovin TG, Chamorro A, Cobo E , et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke[J]. N Engl J Med, 2015,372(24):2296-2306. doi: 10.1056/NEJMoa1503780
[7]	William J, Powers, Colin P , et al. 2015 AHA/ASA focused updated of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment[J]. Stroke, 2015,46(10):3020-3035. doi: 10.1161/STR.0000000000000074
[8]	中国卒中学会, 中国卒中学会神经介入分会, 中华预防医学会卒中预防与控制专业委员会介入学组. 急性缺血性卒中血管内治疗中国指南2015[J]. 中国卒中杂志, 2015,10(7):590-605.
[9]	William J, Alejandro A, Teri BSN , et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2018,49(3):e46-e110. doi: 10.1161/STROKEAHA.117.019582
[10]	Wong KS, Li H . Long-term mortality and recurrent stroke risk among Chinese stroke patients with predominant intracranial atherosclerosis[J]. Stroke, 2003,34(10):2361-2366. doi: 10.1161/01.STR.0000089017.90037.7A
[11]	Nogueira RG, Jadhav AP, Haussen DC , et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct[J]. N Engl J Med, 2018,378(1):11-21. doi: 10.1056/NEJMoa1706442
[12]	Arenillas JF . Intracranial atherosclerosis: current concepts[J]. Stroke, 2011,42(suppl 1):S20-S23. doi: 10.1161/STROKEAHA.110.597278

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Variable	Statistics
Age / years	68.3±5.6
Age≥80 years, n(%)	5(19.2)
Male, n(%)	16(61.5)
Atrial fibrillation, n(%)	6(23.1)
Diabetes mellitus, n(%)	10(38.5)
Hypertension, n(%)	16(61.5)
Previous ischemic stroke or TIA, n(%)	3(11.5)
NIHSS score	12.6±4.2
Treatment with intravenous alteplase, n(%)	8(30.8)
Type of stroke onset, n(%)
On awakening	16(61.5)
Witnessed stroke	4(15.4)
Unwitnessed stroke	6(23.1)
Occlusion site, n(%)
Anterior circulation	18(69.2)
Posterior circulation	8(30.8)
ASPECTS score	7.5±1.2
Time from AIS attack to puncture/h
Anterior circulation, Median	5.4
Posterior circulation, Median	8.1