摘要：

目的: 探讨血管内治疗联合依替巴肽治疗急性缺血性卒中的有效性和安全性。方法: 纳入2019年4月至2020年3月我国15所医疗中心收治的102例急性缺血性卒中患者，均接受血管内治疗联合依替巴肽治疗。以治疗后24 h内血管再通率[改良脑梗死溶栓血流分级（mTICI）≥ 2b级]为主要有效性结局，治疗后24 h内血管完全再通率（mTICI分级3级）及治疗后3个月神经功能预后（改良Rankin量表评分≤ 2分）为次要有效性结局；以治疗后48 h内症状性颅内出血发生率为主要安全性结局，治疗后48 h内颅内出血、脑实质血肿、出血性梗死、远隔部位出血、脑室内出血、蛛网膜下腔出血发生率及治疗后3个月病死率为次要安全性结局。单因素和多因素逐步法Logistic回归分析筛查急性缺血性卒中血管内治疗联合依替巴肽治疗预后影响因素。结果: 治疗后24 h内血管再通率和血管完全再通率分别为86.27%（88/102）和68.63%（70/102），治疗后3个月预后良好率为54.90%（56/102）；治疗后48 h内症状性颅内出血发生率为4.90%（5/102），颅内出血为19.61%（20/102）、脑实质血肿为11.76%（12/102）、出血性梗死为5.88%（6/102）、远隔部位出血为1.96%（2/102）、脑室内出血为3.92%（4/102），未发生蛛网膜下腔出血，治疗后3个月病死率为16.67%（17/102）。Logistic回归分析显示，入院时美国国立卫生研究院卒中量表评分> 15分是急性缺血性卒中患者血管内治疗联合依替巴肽治疗预后不良的危险因素（OR=0.118，95% CI：0.046~0.307；P=0.000），术前Alberta脑卒中计划早期CT评分≥6分是预后良好的保护因素（OR=5.871，95% CI：1.812~19.020；P=0.003）。结论: 血管内治疗联合依替巴肽治疗急性缺血性卒中安全、有效，但尚待针对最佳给药方式的随机对照试验进一步验证。

关键词: 缺血性卒中, 血栓切除术, 依替巴肽, 危险因素, Logistic模型, 前瞻性研究

Abstract:

Objective: To explore the efficacy and safety of endovascular treatment (EVT) combined with eptifibatide in the treatment of acute ischemic stroke. Methods: This study enrolled the 102 acute ischemic stroke patients at 15 centers in China received EVT combined with eptifibatide from April 2019 to March 2020.The primary efficacy outcome was the reperfusion rate of blood vessels within 24 h after treatment [modified Thrombolysis in Cerebral Infarction (mTICI) grade ≥ 2b], while the secondary efficacy outcomes were the complete reperfusion (mTICI grade 3) rate of blood vessels within 24 h after treatment and the 3-month neurological function prognosis [modified Rankin Scale (mRS) score ≤ 2]; the incidence of symptomatic intracranial hemorrhage (sICH) within 48 h after treatment was the primary safety outcome, while the incidence of intracranial hemorrhage (ICH), parenchymal hemorrhage (PH), hemorrhagic infarction (HI), remote parenchymal hemorrhage (rPH), intraventricular hemorrhage (IVH), and subarachnoid hemorrhage (SAH) within 48 h, and 3-month mortality after treatment were secondary safety outcomes.Univariate and multivariate stepwise Logistic regression analyses were used to screen for the influencing factors of prognosis after EVT combined with eptifibatide for acute ischemic stroke. Results: The successful reperfusion (mTICI grade ≥ 2b) rate and complete reperfusion (mTICI grade 3) rate of blood vessels within 24 h after treatment were 86.27% (88/102) and 68.63% (70/102), respectively.The good prognosis (mRS score ≤ 2) rate at 3-month after treatment was 54.90% (56/102).The incidence of sICH within 48 h after treatment was 4.90% (5/102).The incidence of ICH was 19.61% (20/102), PH was 11.76% (12/102), HI was 5.88% (6/102), rPH was 1.96% (2/102), IVH was 3.92% (4/102), and there was no SAH within 48 h after treatment.The mortality rate at 3-month after treatment was 16.67% (17/102).Logistic regression analysis showed that an admission National Institutes of Health Stroke Scale (NIHSS) score of >15 was a risk factor for poor prognosis in patients with acute ischemic stroke after EVT combined with eptifibatide (OR=0.118, 95%CI: 0.046-0.307; P=0.000), while an Alberta Stroke Program Early CT Score (ASPECTS) of ≥ 6 was a protective factor for good prognosis (OR=5.871, 95%CI: 1.812-19.020; P=0.003). Conclusions: The combined regimen of eptifibatide and EVT studied in this trial was effective and safe.Optimal administration method and randomized controlled trial are need to be further justified.

Key words: Ischemic stroke, Thrombectomy, Eptifibatide, Risk factors, Logistic models, Prospective studies