Solitaire支架机械取栓与选择性动脉溶栓治疗急性脑梗死的疗效比较

摘要

Objective To investigate the clinical safety and efficacy of mechanical thrombectomy(MT) with Solitaire stent compared with the selective intra-arterial thrombolysis (IAT) in the treatment of acute cerebral infarction.Methods Totally 82 cases patients with severe acute ischemic stroke caused by middle cerebral artery stenosis from January 2014 to May 2016 in the stroke treatment center of the first people's Hospital in ZunYi city who were applied with the mechanical thrombectomy or the selective intra-arterial thrombolysis was included,and a comparative analysis was conducted on the mTICI rating to assess the interventional recanalization,the NIHSS score after the treatment,bleeding rate,and conditions of neurological functional recovery 90 days after operation.Results There were 42 cases applied with the mechanical thrombectomy (MT group),40 cases applied with the intra-arterial thrombolysis (IAT group).The total effective rate reached 85.70％ in the MT group and 62.50％ in the IAT group,the difference was significant (P ＜ 0.05).Compared with NIHSS score before operation,the score after the treatment showed a decreased trend.And the NIHSS score of MT group was better than that of the IAT group in a week after the treatment (P ＜ 0.05).The bleeding rate was lower in the MT group with statistically significant difference (P ＜ 0.05).Conclusion Compared to IAT,MT can provide broader time window,higher recanalization rate and better outcome in patients with severe acute ischemic stroke.%目的 比较Solitaire支架机械取栓与选择性动脉溶栓治疗急性脑梗死的临床疗效.方法 回顾性分析2014年1月至2016年5月遵义市第一人民医院神经科因大动脉狭窄或闭塞导致急性中重度脑梗死接受动脉溶栓或机械取栓的82例患者的临床资料,比较分析介入治疗后血管再通mTICI评级、治疗前后NIHSS评分、出血情况及90 d神经功能恢复情况.结果 机械取栓42例(机械取栓组),动脉溶栓40例(动脉溶栓组),机械取栓组患者治疗后总有效率达到85.70％,动脉溶栓组总有效率62.50％,2组比较,差异有统计学意义(P＜0.05);与治疗前相比,2组治疗后NIHSS评分呈下降趋势,治疗后1周机械取栓组疗效优于动脉溶栓治疗组,差异具有统计学意义(P＜0.05);机械取栓相比动脉溶栓出血率较低,差异具有统计学意义(P＜0.05).结论 支架机械取栓方法与动脉溶栓比较,时间窗可以适当放宽,溶栓效果、安全性及远期临床预后较好.