作者：郭元展，温昌明，张保朝，孙军，高军，郭士乾

单位：

1.新乡医学院研究生院2.河南省南阳市中心医院神经介入科

单位（英文）：

1.Graduate School of Xinxiang Medical College, Xinxiang 453000, China 2.Neurointerventional Department, Nanyang Central Hospital, Nanyang 473000, China

关键词：

卒中; 急性前循环大血管闭塞性卒中; 机械取栓; 超时间窗; 治疗结果;

关键词（英文）：

Stroke; Acute anterior circulation large vessel occlusion stroke: Mechanical thrombectomy; Beyond time window; Treatment outcome

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2023.00.146

基金项目：

河南省医学科技重点攻关项目（202102310079）

摘要：

目的 分析急性前循环大血管闭塞性卒中患者超时间窗机械取栓的治疗效果。方法 本研究为回顾性队列研究。选取2019年1月至2022年5月在南阳市中心医院住院治疗的急性前循环大血管闭塞性卒中患者93例，其发病至入院时间均>24 h，且影像学检查显示存在明显的缺血半暗带。根据患者是否接受机械取栓将其分为对照组（n=49）和取栓组（n=44）。对照组患者给予常规药物治疗和标准护理，取栓组患者在对照组基础上进行机械取栓。比较两组患者基线资料、影像学资料，记录取栓组患者手术相关情况。所有患者于术后90 d通过电话进行随访，主要结局指标为术后90 d改良Rankin量表（mRS）评分，次要结局指标为术后90 d预后良好（mRS评分为0～2分）、mRS评分为0～3分、死亡、脑梗死复发情况及症状性颅内出血（sICH）发生情况。结果 取栓组患者手术方式：单纯抽吸取栓5例（11%），支架取栓39例（89%）；手术相关并发症：动脉夹层2例（5%），新发部位栓塞3例（7%）；取栓次数为1(1)次；植入支架19例（43%）;mTICI分级：0～1级2例（5%）,2a级3例（7%）,2b级27例（61%）,3级12例（27%）；术后造影剂外渗8例（18%）。取栓组术后90 d mRS评分低于对照组，预后良好、mRS评分0～3分者占比高于对照组（P<0.05）；两组术后90 d死亡率、脑梗死复发率、s ICH发生率比较，差异无统计学意义（P>0.05）。结论 与常规药物治疗相比，超时间窗（发病24 h以上）机械取栓能更有效改善存在明显缺血半暗带的急性前循环大血管闭塞性卒中患者90 d神经功能预后。

英文摘要：

Objective To analyze the effect of mechanical thrombectomy beyond time window in the treatment of patients with acute anterior circulation large vessel occlusion stroke. Methods This study was a retrospective cohort study. A total of 93 patients with acute anterior circulation large vessel occlusion stroke who were hospitalized in Nanyang Central Hospital from January 2019 to May 2022 were selected. The time from onset to admission of the patients was > 24 h, and imaging examination showed obvious ischemic penumbra. They were divided into control group (n=49) and thrombectomy group (n=44) according to whether the patients received mechanical thrombectomy. The control group was given routine medical treatment and standard nursing, and the thrombectomy group was given mechanical thrombectomy on the basis of the control group. The baseline data and imaging data of the two groups were compared, and the operationrelated conditions of the patients in the thrombectomy group were recorded. All patients were followed up by telephone at 90 days after operation. The primary outcome was modified Rankin Scale (mRS) score at 90 days after operation, and the secondary outcome was good prognosis (mRS score of 0-2) , mRS score of 0-3, death, recurrence of cerebral infarction and symptomatic intracranial hemorrhage (sICH) at 90 days after operation. Results In the thrombectomy group, there were 5 cases (11%) of simple aspiration and 39 cases (89%) of stent thrombectomy. Surgery-related complications: 2 cases (5%) had arterial dissection, 3 cases (7%) had new site embolism; the number of thrombectomy was 1 (1) time; stents were implanted in 19 cases (43%) . According to mTICI classification, there were 2 cases (5%) of grade 0-1, 3 cases (7%) of grade 2a, 27 cases (61%) of grade 2b and 12 cases (27%) of grade 3. Postoperative contrast agent extravasation occurred in 8 cases (18%) . The mRS score at 90 days after operation in the thrombectomy group was lower than that in the control group, and the the proportion of patients with good prognosis and mRS score of 0-3 points were higher than those in the control group (P < 0.05) . There was no significant difference in mortality, recurrence rate of cerebral infarction and incidence of sICH between the two groups at 90 days after operation (P > 0.05) . Conclusion Compared with conventional drug therapy, mechanical thrombectomy beyond time window (more than 24 h after onset) can more effectively improve the 90 d neurological prognosis of acute anterior circulation large vessel occlusion stroke with obvious ischemic penumbra.

参考文献：