动脉夹层所致急性前循环大血管闭塞性卒中血管内治疗疗效分析

doi:10.3969/j.issn.1673-5765.2020.10.004

摘要/Abstract

摘要：

目的探讨颈动脉夹层引起的急性前循环大血管闭塞性缺血性卒中血管内治疗的安全性和有效性。方法回顾性纳入2019年1-12月在南方医科大学深圳医院连续行急诊血管内治疗的前循环大血管闭塞患者，根据血管闭塞病因分为动脉夹层组和非动脉夹层组。血管再通效率指标为穿刺-血管再通时间和影像学上血管成功再通（mTICI≥2b级），主要的疗效评价指标为90 d良好预后（mRS评分≤2 分），主要安全评价指标为术后24 h内症状性颅内出血。结果共纳入56例，平均年龄58.5±9.7岁，男性42例（75.0%），12例为动脉夹层引起的血管闭塞， 44例为非动脉夹层引起的血管闭塞。两组患者90 d良好预后率（83.3% vs 61.4%，P =0.189）、24 h症状性颅内出血率（25.0% vs 31.8%，P =0.738）、血管成功再通率（91.7% vs 93.2%，P＞0.99）均无统计学差异，动脉夹层组穿刺-血管再通时间长于非动脉夹层组（124.5 min vs 83 mi n，P =0.008）。结论颈动脉夹层引起的急性前循环大血管闭塞性卒中，行血管内治疗安全有效。

文章导读： 本研究显示颈动脉夹层引起的急性大血管闭塞性卒中，合并串联病变比例较高，血管开通时间偏长，但整体预后良好。

关键词: 动脉夹层; 缺血性卒中; 大血管闭塞; 血管内治疗

Abstract:

Objective To investigate the safety and efficacy of endovascular treatment for acute anterior circulation large vessel occlusion stroke due to cervical artery dissection. Methods Data of consecutive patients with anterior circulation large vessel occlusion who received emergency endovascular treatment in Shenzhen Hospital of Southern Medical University from January 2019 to December 2019 were retrospectively analyzed. According to the etiology of vascular occlusion, the patients were divided into dissection group and non-dissection group, and efficacy and safety of endovascular treatment between the two groups were compared. Indicators of recanalization efficiency were the puncture-to-recanalization time and successful recanalization (mTICI ≥2b). The primary efficacy endpoint was 90-day prognosis, and good prognosis was defined as a mRS score of 0-2. The safety indicator was symptomatic intracranial hemorrhage within 24 hours after surgery. Results A total of 56 were included, with an average age of 58.5±9.7 years and 42 (75.0%) males, 12 cases in dissection group and 44 in non-dissection group. No significant differences were observed in 90-day good prognosis rate (83.3% vs 61.4%, P =0.189), symptomatic intracranial hemorrhage rate (25.0% vs 31.8%, P =0.738) and successful recanalization rate (91.7% vs 93.2%, P >0.99). The dissection group had longer puncture-to-recanalization time than non-dissection group(124.5 min vs 83 min, P =0.008). Conclusions Endovascular treatment is safe and effective for acute anterior circulation large vessel occlusion stroke caused by artery dissection.

Key words: Artery dissection; Ischemic stroke; Large vessel occlusion; Endovascular treatment

张亮，贺雄军，黎凯锋，黎杰，胡明，刘亚杰. 动脉夹层所致急性前循环大血管闭塞性卒中血管内治疗疗效分析[J]. 中国卒中杂志, 2020, 15(10): 1053-1057.

ZHANG Liang, HE Xiong-Jun, LI Kai-Feng, LI Jie, HU Ming, LIU Ya-Jie. Endovascular Treatment for Acute Anterior Circulation Large Vessel Occlusion Stroke due to Cervical Artery Dissection[J]. Chinese Journal of Stroke, 2020, 15(10): 1053-1057.

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