不同类型基底动脉闭塞机械取栓的疗效观察

目的评价机械取栓治疗不同类型基底动脉(BA)闭塞的疗效。方法回顾性分析2013年9月至2019年9月海军军医大学附属长海医院脑血管病中心连续收治的95例行机械取栓治疗的BA闭塞患者的临床资料。根据BA闭塞是否为串联病变,分为非串联病变组(67例)和串联病变组(28例)。比较两组血管成功再通(改良脑梗死溶栓分级2b~3级)的比例、90 d预后良好(改良Rankin量表评分为0~3分)的比例、术中挽救措施及不良事件发生率等的差异。结果与非串联病变组相比,串联病变组的年龄偏低(P=0.002),而男性(P=0.009)、有吸烟史(P=0.014)、缺血性卒中TOAST分型为大动脉粥样硬化型(P=0.001)以及存在一侧椎动脉发育不良(P=0.036)的比例更高。两组患者在术前及术后24 h的美国国立卫生院卒中量表评分、股动脉穿刺至BA再灌注时间、血管成功再通比例及90 d预后良好比例方面的差异均无统计学意义(均P>0.05)。串联病变组的发病至就诊时间(P=0.049)、发病至BA再灌注时间(P=0.046)均较非串联病变组延长,且术中挽救措施(包括单纯球囊扩张、急诊支架置入、静脉应用替罗非班)的使用比例均更高(均P<0.05)。两组在手术相关的不良事件及病死率方面的差异均无统计学意义(均P>0.05)。结论对于不同类型的BA闭塞患者,应用机械取栓治疗的临床结局及不良事件的发生率无明显差异,但该结论仍需进一步扩大样本量或进行随机对照试验加以证实。

Efficacy of mechanical thrombectomy for different types of basilar artery occlusions

Objective To evaluate the efficacy of mechanical thrombectomy for patients with different types of basilar artery(BA)occlusions.Methods A retrospective analysis was conducted on the clinical data of 95 consecutively enrolled patients with BA occlusions.All those patients underwent endovascular treatment at the Center of Cerebrovascular Diseases,Changhai Hospital,Naval Medical University from September 2013 to September 2019.According to whether the occlusion was of the tandem type or not,all 95 cases were divided into the non-tandem occlusion group(67 cases)and the tandem occlusion group(28 cases).Comparisons of the proportions of successful recanalization[modified thrombolysis in cerebral infarction(mTICI)score of 2b-3]and good outcomes[modified Rankin Scale(mRS)of 0-3]at 90 d,intraoperative rescue measures and the incidence of adverse events between the two groups were conducted.Results Compared with the non-tandem occlusion group,patients in the tandem occlusion group had lower ages(P=0.002),higher ratio of male(P=0.009)and smoking history(P=0.014),higher proportions of the large artery atherosclerosis of TOAST(P=0.001)and unilateral vertebral artery hypoplasia(P=0.036).There were no significant differences between the two groups in the scores of National Institutes of Health Stroke Scale(NIHSS)prior to operation and then at 24 h post operation,time period from the puncture of femoral artery to the reperfusion of BA,ratios of successful recanalization or good outcomes(all P>0.05).Both onset-to-triage time and onset-to-reperfusion time were longer in the tandem occlusion group than those in the non-tandem occlusion group(P=0.049,P=0.046).Furthermore,the proportions of intraoperative rescue measures,including balloon dilatation alone,emergency stent implantation and intravenous administration of tirofiban,were higher in the tandem occlusion group than non-tandem occlusion group(all P<0.05).No significant differences were found between the two groups in the incidence of the procedure-associated adverse events or mortality(both P>0.05).Conclusions No differences have been noted in the clinical outcomes or adverse events between the patients of different types of BA occlusions who undergo mechanical thrombectomy.Nevertheless,studies with large sample size and randomized controlled trials are required to confirm the findings.