Chinese Journal of Contemporary Neurology and Neurosurgery ›› 2025, Vol. 25 ›› Issue (5): 441-446. doi: 10.3969/j.issn.1672-6731.2025.05.013

• Basic and Clinical Study • Previous Articles     Next Articles

Clinical effect analysis of recanalization treatment for acute ischemic stroke with large infarct core caused by intracranial atherosclerotic stenosis and cardiac embolism

Jin-zhao ZHU1, Wei-zheng XIE1, Jian-gang ZHANG1, Guang FENG2,*()   

  1. 1. Department of Neurology, The People's Hospital of Anyang City, Anyang 455000, He'nan, China
    2. Department of Neurosurgery Intensive Care Unit, He'nan Provincial People's Hospital, Zhengzhou 450000, He'nan, China
  • Received:2025-04-25 Online:2025-05-25 Published:2025-06-05
  • Contact: Guang FENG
  • Supported by:
    Provincial-Ministry Co-construction Project of Medical Science and Technology Research Program in He'nan(SBGJ202402008)

颅内动脉粥样硬化性狭窄与心源性栓塞引起的伴大梗死核心急性缺血性卒中血管再通疗效分析

朱金钊1, 谢卫征1, 张建刚1, 冯光2,*()   

  1. 1. 455000 河南省安阳市人民医院神经内科
    2. 450000 郑州,河南省人民医院神经外科重症监护室
  • 通讯作者: 冯光
  • 基金资助:
    河南省医学科技攻关计划省部共建重点项目(SBGJ202402008)

Abstract:

Objective: To investigate the short -term efficacy, long -term outcome and safety of recanalization treatment in patients with acute ischemic stroke presenting with large infarct core caused by intracranial atherosclerotic stenosis (ICAS) versus cardiac embolism (CE). Methods: A total of 96 acute ischemic stroke patients with large infarct core who underwent recanalization treatment at The People's Hospital of Anyang City from January 2022 to January 2023 were enrolled. Based on etiology, patients were divided into ICAS group (n = 52) and CE group (n = 44). Short-term efficacy was assessed using the National Institutes of Health Stroke Scale (NIHSS) at 14 d postoperatively, while long -term outcome was evaluated using the modified Rankin Scale (mRS) at 90 d postoperatively. Safety outcome included rate of symptomatic intracranial hemorrhage (sICH), intracranial hemorrhage, cerebral herniation within 24 h postoperatively, and fatality rate at 90 d postoperatively. Results: A statistically significant difference in NIHSS score was observed between the ICAS group and the CE group (F = 5.821, P = 0.023), with the CE group having higher NIHSS score than the ICAS group at admission (t = -2.324, P = 0.022). Both groups showed significant differences in NIHSS score between admission and 14 d postoperatively (F = 589.322, P = 0.000), with the CE group demonstrating lower NIHSS score at 14 d postoperatively compared to admission (t = 4.173, P = 0.001). The ICAS group exhibited a higher rate of favorable outcome at 90 d postoperatively [44.23% (23/52) vs. 25% (11/44); χ2 = 3.853, P = 0.050]. No significant differences were observed between the 2 groups in sICH, intracranial hemorrhage, cerebral herniation rate, or 90 d fatality rate (P > 0.05, for all). Conclusions: Recanalization treatment for acute ischemic stroke patients with large infarct core caused by CE demonstrates more pronounced short-term efficacy, while ICAS presenting with better long-term outcome, and there is no significant difference in safety between the 2 groups.

Key words: Ischemic stroke, Intracranial arteriosclerosis, Heart disease, Thrombectomy, Stents, Saccule and utricle, Prognosis

摘要:

目的: 对比分析颅内动脉粥样硬化性狭窄(ICAS)与心源性栓塞(CE)引起的伴大梗死核心急性缺血性卒中患者血管再通治疗的短期疗效、长期预后及安全性。方法: 共纳入2022年1月至2023年1月河南省安阳市人民医院收治的96例伴大梗死核心急性缺血性卒中患者,均行血管再通治疗,根据病因分为ICAS组(52例)和CE组(44例),采用美国国立卫生研究院卒中量表(NIHSS)评价术后14 d短期疗效,采用改良Rankin量表(mRS)评价术后90 d长期预后,并记录术后24 h内症状性颅内出血、颅内出血、脑疝发生率及术后90 d病死率。结果: ICAS组与CE组NIHSS评分差异具有统计学意义(F = 5.821,P = 0.023),其中入院时CE组NIHSS评分高于ICAS组(t = - 2.324,P = 0.022);两组入院时与术后14 d NIHSS评分差异亦有统计学意义(F = 589.322,P = 0.000),其中CE组术后14 d NIHSS评分低于入院时(t = 4.173,P = 0.001)。ICAS组术后90 d预后良好率高于CE组[44.23%(23/52)对25%(11/44);χ2 = 3.853,P = 0.050]。两组术后24 h内症状性颅内出血、颅内出血和脑疝发生率及术后90 d病死率差异均无统计学意义(P > 0.05)。结论: 心源性栓塞引起的伴大梗死核心急性缺血性卒中患者血管再通治疗的短期疗效更佳,病因为颅内动脉粥样硬化性狭窄的患者长期预后更佳,二者安全性无明显差异。

关键词: 缺血性卒中, 颅内动脉硬化, 心脏病, 血栓切除术, 支架, 球囊和椭圆囊, 预后