急性大脑中动脉M2段闭塞致缺血性卒中支架取栓术与直接抽吸取栓术对比分析

doi:10.3969/j.issn.1672-6731.2022.09.011

摘要/Abstract

摘要： 目的对比分析支架取栓术与直接抽吸取栓术治疗急性大脑中动脉M2段闭塞致缺血性卒中的有效性和安全性。方法纳入2016年3月至2021年3月在湖北省武汉市第一医院行血管内治疗的44例急性大脑中动脉M2段闭塞致缺血性卒中患者，分别行支架取栓术（支架组，22例）和直接抽吸取栓术（抽吸组，22例），详细记录发病至手术结束时间、术后即刻血管再通率（改良脑梗死溶栓血流分级 ≥ 2b级）、术后90 d预后良好率（改良Rankin量表评分 ≤ 2分）和病死率、症状性颅内出血和无症状性颅内出血发生率。结果共44例患者，血管再通率为77.27%（34/44），其中支架组为68.18%（15/22），抽吸组为86.36%（19/22）但有5例血管再通欠佳改行支架取栓术。两组患者穿刺至手术结束时间（t=0.978，P=0.334）、血管再通率（χ²=2.071，P=0.150）、术后90 d预后良好率（χ²=0.364，P=0.546）和病死率（χ²=0.193，P=0.660）、症状性颅内出血（χ²=0.524，P=0.469）和无症状性颅内出血（χ²=0.275，P=0.600）发生率差异均无统计学意义。结论支架取栓术和直接抽吸取栓术治疗急性大脑中动脉M2段闭塞致缺血性卒中安全、有效，尚待多中心大样本随机对照试验进一步验证。

关键词: 动脉闭塞性疾病, 大脑中动脉, 支架, 抽吸, 血栓切除术

Abstract: Objective To analyze the effectivity and safety of stent thrombectomy and direct aspiration thrombectomy in the treatment of ischemic stroke caused by acute middle cerebral artery (MCA) M2 segment occlusion. Methods A total of 44 patients with ischemic stroke caused by acute MCA M2 segment occlusion who received endovascular therapy in Wuhan No. 1 Hospital from March 2016 to March 2021 were selected, including 22 patients with stent thrombectomy and 22 patients with direct aspiration thrombectomy. Time from onset to the end of surgery, postoperative immediate recanalization rate[modified Thrombolysis in Cerebral Infarction Score (mTICI) ≥ 2b], postoperative 90-day good prognosis rate[modified Rankin Scale (mRS) ≤ 2], mortality, rate of symptomatic intracranial hemorrhage (sICH) and asymptomatic intracranial hemorrhage (asICH) were recorded. Results The postoperative recanalization rate in the total 44 patients was 77.27% (34/44), while 68.18% (15/22) in the stent group and 86.36% (19/22) in the aspiration group. Five patients in the aspiration group had poor result with aspiration and were remedied with stent thrombectomy. There was no statistic difference in the time from puncture to the end of the surgery (t=0.978, P=0.334), recanalization rate (χ²=2.071, P=0.150), postoperaitve 90-day good prognosis rate (χ²=0.364, P=0.546), mortality (χ²=0.193, P=0.660), incidence of sICH (χ²=0.524, P=0.469) and asICH (χ²=0.275, P=0.600). Conclusions This preliminary study showed that stent thrombectomy and direct aspiration thrombectomy in patients with ischemic stroke caused by acute MCA M2 segment occlusion are safe and effective, but further exploration of multicentre, large-sample randomised controlled trials is needed.

Key words: Arterial occlusive diseases, Middle cerebral artery, Stents, Suction, Thrombectomy

郭章宝, 许项前, 谌敏, 段振晖, 唐坤, 刘文华. 急性大脑中动脉M2段闭塞致缺血性卒中支架取栓术与直接抽吸取栓术对比分析[J]. 中国现代神经疾病杂志, 2022, 22(9): 810-816.

GUO Zhang-bao, XU Xiang-qian, CHEN Min, DUAN Zhen-hui, TANG Kun, LIU Wen-hua. A comparative study of stent thrombectomy and direct aspiration thrombectomy in the treatment of ischemic stroke caused by acute middle cerebral artery M2 segment occlusion[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2022, 22(9): 810-816.

http://journal11.magtechjournal.com/cjcnn/CN/Y2022/V22/I9/810

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2 急性大脑中动脉M2段闭塞致缺血性卒中支架取栓术与直接抽吸取栓术对比分析

A comparative study of stent thrombectomy and direct aspiration thrombectomy in the treatment of ischemic stroke caused by acute middle cerebral artery M2 segment occlusion

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