Abstract:

Objective To evaluate the efficacy and safety of mechanical thrombectomy for acute ischemic stroke (AIS) under the COVID-19 epidemic. Methods The data of patients who underwent mechanical thrombectomy for intracranial large artery occlusion at Neurointervention Center, Beijing Tian Tan Hospital, Capital Medical University from January 20 to March 20, 2020 were retrospectively collected. Patients with thrombectomy from January 20 to March 20 in 2019 were included as a control group, the cases in 2020 as observation group, and the data of two groups were compared. Results A total of 33 patients were included, with 18 cases in 2020 and 15 cases in 2019. Compared with the control group, the time from door to puncture was slightly longer [4.0 (2.9- 4.1) h vs 3.0 (2.0-4.0) h, P =0.103], general anesthesia was less used in thrombectomy (55.6% vs 100.0%, P =0.003), and direct aspiration thrombectomy as first-pass mechanical thrombectomy was more preferred (27.8% vs 13.3%, P =0.32) and the mortality at discharge was lower (0 vs 20.0%, P =0.050) in observation group. There were no suspicious COVID-19, or confirmed COVID-19 cases in patients and medical staff participating in the treatment of these patients in 2020. Conclusions During the outbreak of epidemic, emergency thrombectomy was affected by COVID-19 screening and the time from door to puncture was prolonged, and the treatment strategy were inclined to conscious sedation and aspiration thrombectomy, which was reasonable as a special consideration during the epidemic.

摘要：

目的 探讨总结新型冠状病毒（coronavirus disease-19，COVI D-19）肺炎疫情时期急性缺血性卒中 （acute ischemic stroke，AIS）的急诊取栓治疗经验。 方法 回顾性分析2020年1月20日-3月20日疫情期间，首都医科大学附属北京天坛医院神经介入中 心进行急诊取栓治疗的AIS病例资料，包括患者的一般资料、NIHSS评分、ASPECTS评分（DWI）、病变部 位、手术策略、恢复情况，以及COVID-19筛查、预防标准与流程。并与2019年1月20日-3月20日同期取栓 病例进行对照分析。 结果 共纳入33例颅内大血管闭塞致AIS进行急诊取栓的患者，其中2020年18例，2019年15例。2020 年疫情期间与2019年同期相比，入院到手术开始时间稍长[4.0（2.9～4.1）h vs 3.0（2.0～4.0）h， P =0.103]，更少采用全身麻醉（55.6% vs 100.0%，P =0.003），更倾向采取直接导管抽吸取栓（27.8% vs 13.3%，P =0.32）。出院时死亡率低于2019年同期取栓患者（0 vs 20.0%，P =0.050）。2020年疫情期 间纳入的患者及参与救治的医护人员无COVID-19可疑病例，无COVI D-19疑似或确诊病例。 结论 COVID-19疫情期间，入院到手术开始时间受到疫情筛查的影响而有所延长，取栓策略倾向于 采取局部麻醉、抽吸取栓策略，作为疫情期间的特殊考虑是合理的。

关键词: 新型冠状病毒; 肺炎; 急性缺血性卒中; 急诊取栓