动脉粥样硬化性和心源性颅内大血管闭塞对血管内治疗反应性差异研究

摘要

Objective To investigate the clinical characteristics and the difference of response of endovascular treatment in patients with acute large artery occlusion caused by intracranial atherosclerotic disease (IAD) and cardioembolism (CE) reason. Methods A retrospective analysis of data of patients with acute ischemic stroke with large artery occlusion who received endovascular treatment in our center was performed. The clinical characteristics, ways of endovascular treatment, vascular recanalization status, peri-operational complications and post-operation improvement of neurological functions were compared. Results A total of 46 patients who received endovascular treatment were categorized to CE group (n=22) and underlying IAD group (n=24). Prevalence of male (75% vs 36%, P=0.008), tobacco (33% vs 9%, P=0.046) in IAD group were higher than CE group, and the prevalence of AF was significantly higher than IAD group (0% vs 82%, P<0.001). The prevalence of acute angioplasty with or without stenting was higher in IAD group (67% vs 27%, P=0.008). There were no significant difference in rate of final recanalization, procedure complications and post-operation improvement of neurological functions. Conclusion Clinical risk factors and treatment strategy for acute arterial occlusions due to IAD may differ from those due to CE. Endovascular recanalization treatment in patients with acute large artery occlusion caused by IAD always needs the combination of angioplasty.%目的 探讨动脉粥样硬化性和心源性前循环颅内大血管闭塞患者的临床特点以及对血管内治疗反应性的差异.方法 回顾性分析行血管内治疗的前循环颅内大血管闭塞的急性缺血性卒中患者的临床资料,比较动脉粥样硬化性和心源性大血管闭塞患者的临床特点、血管内治疗方式、血管开通情况、围手术期并发症及术后神经功能改善状况等.结果 共纳入行血管内治疗的前循环大血管闭塞性缺血性卒中患者46例,其中动脉粥样硬化性组24例,心源性栓塞组22例,相比心源性栓塞组,动脉粥样硬化组中吸烟(33%vs 9%,P=0.046)、男性(75%vs 36%,P=0.008)比例显著较高,心房颤动史显著较低(0%vs 82%,P<0.001).动脉粥样硬化组联合使用血管成形术的比例较高(67%vs 27%,P=0.008).两组患者血管内治疗最终整体再通率、术中并发症、术后神经功能改善方面均未见显著差异.结论 动脉粥样硬化与心源性栓塞导致的大血管闭塞性急性前循环缺血性卒中相比,其危险因素和血管内开通措施有所不同,动脉粥样硬化性大血管闭塞患者血管内治疗往往需要联合血管成形术.