摘要：

目的: 探讨急性进展性前循环大血管闭塞性缺血性卒中患者血管内机械取栓术的有效性和安全性。方法: 纳入2020年1月至2023年4月河北省人民医院诊断与治疗的414例急性前循环大血管闭塞性缺血性卒中患者，分别行“时间窗”内机械取栓术（时间窗内取栓组，293例）、进展性脑卒中机械取栓术（进展取栓组，45例）和标准内科治疗（内科组，76例），以治疗后3个月神经功能预后[改良Rankin量表（mRS）]作为主要结局、术后即刻血管再通率[改良脑梗死溶栓血流分级（mTICI）]作为次要结局，记录治疗后症状性脑出血发生率和3个月全因死亡率。结果: 3组患者神经功能预后差异有统计学意义（χ²=19.572，P=0.000），其中进展取栓组（Z=-2.829，P=0.005）和时间窗内取栓组（Z=-4.422，P=0.000）预后良好率均高于内科组，而时间窗内取栓组与进展取栓组神经功能预后差异无统计学意义（Z=-0.525，P=0.600）。Logistic回归分析显示，治疗前美国国立卫生研究院卒中量表评分高（OR=1.298，95% CI：1.216~1.385；P=0.000）和内科治疗（OR=7.572，95% CI：3.048~18.809；P=0.000）是急性前循环大血管闭塞性缺血性卒中患者预后不良的危险因素，机械取栓术是预后良好的保护因素（OR=0.431，95% CI：0.212~0.879；P=0.021）。进展取栓组与时间窗内取栓组术后即刻血管再通率差异无统计学意义（χ²=0.218，P=0.640）。3组治疗后症状性脑出血发生率差异有统计学意义（χ²=6.575，P=0.037），其中时间窗内取栓组高于内科组（Z=-2.376，P=0.018）；3个月全因死亡率差异无统计学意义（χ²=5.178，P=0.075）。结论: 急性进展性前循环大血管闭塞性缺血性卒中患者行机械取栓术具有较好的疗效和安全性。

关键词: 缺血性卒中, 大脑动脉环, 动脉闭塞性疾病, 血栓切除术, 预后, 危险因素, Logistic模型

Abstract:

Objective: To investigate the efficacy and safety of mechanical thrombectomy in patients with acute progressive ischemic stroke with large vessel occlusion in the anterior circulation. Methods: From January 2020 to April 2023, 414 patients with acute progressive ischemic stroke with large vessel occlusion in the anterior cirulation in Hebei General Hospital were included.According to the time of onset and whether the patients underwent mechanical thrombectomy, the patients were divided into direct mechanical thrombectomy group (n=293), progressive stroke mechanical thrombectomy group (n=45), and standard medical treatment group (n=76).The modified Rankin Scale (mRS) and modified Thrombolysis in Cerebral Infarction (mTICI) were used to evaluate neurological prognosis and vascular recanalization.The incidence of symptomatic intracranial hemorrhage after treatment and 3-month all-cause mortality were recorded. Results: There was a statistically significant difference in neurological prognosis among the 3 groups (χ²=19.572, P=0.000).The rate of good prognosis in standard medical treatment group was lower than that progressive stroke mechanical thrombectomy group (Z=-2.829, P=0.005) and direct mechanical thrombectomy group (Z=-4.422, P=0.000), while there was no statistically significant difference in the rate of good prognosis between direct mechanical thrombectomy group and progressive stroke mechanical thrombectomy group (Z=-0.525, P=0.600).Logistic regression analysis showed that high National Institutes of Health Stroke Scale (NIHSS) score before treatment (OR=1.298, 95%CI: 1.216-1.385; P=0.000) and standard medical treatment (OR=7.572, 95%CI: 3.048-18.809; P=0.000) were the risk factors for poor prognosis, and direct mechanical thrombectomy was the protective factor for good prognosis (OR=0.431, 95%CI: 0.212-0.879; P=0.021).There was no statistically significant difference in the vascular recanalization rate between progressive stroke mechanical thrombectomy group and direct mechanical thrombectomy group (χ²=0.218, P=0.640).There was a statistically significant difference in the incidence of symptomatic intracranial hemorrhage after treatment among the 3 groups (χ²=6.575, P=0.037), and direct mechanical thrombectomy group was higher than that of standard medical treatment group (Z=-2.376, P=0.018).There was no statistically significant difference in the 3-month all-cause mortality (χ²=5.178, P=0.075). Conclusions: Mechanical thrombectomy is feasible in patients with acute progressive ischemic stroke with large vessel occlusion in the anterior circulation, and has a good efficacy and safety.

Key words: Ischemic stroke, Circle of Willis, Arterial occlusive diseases, Thrombectomy, Prognosis, Risk factors, Logistic models