超选动脉内溶栓治疗急性视网膜中央动脉闭塞的疗效探讨

doi:10.3969/j.issn.1673-5765.2022.07.017

摘要/Abstract

摘要：

目的探讨超选动脉内溶栓（intra-arterial thrombolysis，IAT）治疗急性视网膜中央动脉闭塞（central retinal artery occlusion，CRAO）的疗效。

方法回顾性纳入首都医科大学附属北京同仁医院神经外科2019年4月-2020年5月连续收治的CRAO且经超选IAT治疗的患者，记录患者的临床特点。治疗后1周进行最佳矫正视力（best-corrected visual acuity，BCVA）检查，判断视觉改善情况。根据术后视觉有无改善分为视觉改善组和视觉未改善组，比较2组的人口学信息、临床特点及病变侧颈动脉狭窄情况。根据IAT术前或术中DSA影像判断病变侧颈动脉狭窄情况，采用华法林-阿司匹林治疗症状性颅内动脉疾病（warfarin and aspirin for symptomatic intracranial disease，WASID）研究标准计算颈动脉狭窄程度，将患者分为颈动脉狭窄/闭塞（颈动脉狭窄≥50%）组和无狭窄（颈动脉狭窄<50%）组，比较2组的人口学信息、临床特点和术后视觉改善情况。

结果共入组18例CRAO患者，男性12例（66.7%），女性6例（33.3%），年龄中位数52.5（38.8～64.3）岁，1例（5.6%）治疗第二天发现少量大脑皮层出血。视觉改善组5例，视觉未改善组13例，2组的人口学信息、临床特点差异无统计学意义，视觉改善组的病变侧颈动脉狭窄率有低于视觉未改善组的趋势（20.0% vs. 53.8%），但差异未达统计学意义。颈动脉狭窄/闭塞组8例，无狭窄组10例，2组的人口学信息、临床特点差异无统计学意义，颈动脉狭窄/闭塞组的视觉改善率有低于无狭窄组的趋势（12.5% vs. 40.0%），但差异未达统计学意义。

结论 CRAO患者进行IAT治疗具有较好的治疗效果，但治疗后视觉改善的影响因素尚不确定，仍需进一步的研究进行验证。

文章导读： IAT治疗CRAO相对安全、有效，但目前IAT治疗后预后的影响因素尚不明确，本研究发现伴有病变侧颈动脉狭窄的患者治疗后视觉改善率较无颈动脉狭窄的患者有降低的趋势，但限于样本量原因，该趋势未达统计学意义。

关键词: 视网膜中央动脉; 闭塞; 超选动脉溶栓; 视力

Abstract:

Objective To investigate the efficacy of superselective intra-arterial thrombolysis (IAT) in treatment of acute central retinal artery occlusion (CRAO).

Methods Consecutive patients diagnosed with CRAO and treated with superselective IAT at Department of Neurosurgery of Beijing Tongren Hospital Affiliated to Capital Medical University from April 2019 to May 2020 were included in this study, and the clinical data of all patients were collected. The best corrected visual acuity (BCVA) examination was routinely performed by ophthalmologists one week after treatment to evaluate vision improvement. The patients were divided into vision improvement group and no improvement group according to their vision improvement situation. The demographic information, clinical characteristics and culprit carotid stenosis were compared between the two groups. According to the degree of carotid artery stenosis, the patients were divided into carotid artery stenosis/occlusion (carotid artery stenosis ≥50%) subgroup and no stenosis (carotid artery stenosis <50%) subgroup, and the demographic information, clinical characteristics and postoperative vision improvement were compared between the two subgroups.

Results A total of 18 patients with CRAO were included, with a median age of 52.5 (38.8-64.3) years and 12 males (66.7%). A small amount of cortical hemorrhage was found in 1 patient (5.6%) on the second day after treatment. There were 5 patients in vision improvement group and 13 patients in no improvement group. There were no statistical differences in demographic information and clinical characteristics between the two groups. The stenosis rate of carotid artery in vision improvement group was lower than that in no improvement group (20.0% vs. 53.8%), without statistical difference. There were 8 patients in carotid stenosis/occlusion subgroup and 10 patients in no-stenosis subgroup. There were no statistical differences in demographic information and clinical characteristics between the two subgroups. The rate of vision improvement in carotid stenosis/occlusion subgroup was lower than that in no-stenosis group (12.5% vs. 40.0%), without statistical difference.

Conclusions IAT for CRAO has a good therapeutic effect, but the influencing factors of vision improvement after treatment are still uncertain.

Key words: Central retinal artery; Occlusion; Superselective intra-arterial thrombolysis; Vision

王卫, 赵尚峰, 张宝瑞, 梁熙虹, 康军. 超选动脉内溶栓治疗急性视网膜中央动脉闭塞的疗效探讨[J]. 中国卒中杂志, 2022, 17(07): 774-779.

WANG Wei, ZHAO Shangfeng, ZHANG Baorui, LIANG Xihong, KANG Jun. Efficacy of Superselective Intra-arterial Thrombolysis in Treatment of Acute Central Retinal Artery Occlusion[J]. Chinese Journal of Stroke, 2022, 17(07): 774-779.

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