作者：马迎辉，胡骁

单位：

435000湖北省黄石市中心医院 湖北理工学院附属医院神经外科

Units：

Department of Neurosurgery, Huangshi Central Hospital/Affiliated Hospital of Hubei Polytechnic University, Huangshi435000, China

关键词：

卒中；颈内动脉串联病变；颅内动脉；机械取栓；颈内动脉；支架植入术

Keywords：

Stroke; Internal carotid artery tandem lesion; Intracranial artery; Mechanical thrombectomy; Internalcarotid artery; Stent implantation

CLC：

R 743

DOI：

10.12114/j.issn.1008-5971.2023.00.298

Funds：

湖北省自然科学基金资助项目（2019CFB325）

摘要：

目的　观察颅内动脉机械取栓后颈内动脉支架植入术治疗颈内动脉串联病变所致脑卒中的临床疗效。方法　选取2019—2022年在黄石市中心医院接受治疗的颈内动脉串联病变所致脑卒中患者98例，采用随机数字表法将其分为对照组和研究组，每组49例。对照组患者静脉溶栓治疗后行颈内动脉支架植入术，研究组患者颅内动脉机械取栓后行颈内动脉支架植入术。比较两组临床疗效、TIMI血流分级及治疗前后美国国立卫生研究院卒中量表（NIHSS）评分、改良Rankin量表（mRS）评分、Brathel指数、凝血功能指标〔凝血酶原时间（PT），活化部分凝血活酶时间（APTT），组织型纤溶酶原激活物（t-PA），纤溶酶原激活物抑制剂1（PAI-1）〕，记录两组术后1 d颅内出血发生率及术后3个月责任血管再闭塞发生率、死亡率。结果　研究组临床疗效、TIMI血流分级优于对照组（P＜0.05）。治疗后，两组NIHSS评分、mRS评分分别低于本组治疗前，Barthel指数分别高于本组治疗前，且研究组NIHSS评分、mRS评分低于对照组，Barthel指数高于对照组（P＜0.05）。治疗后，两组PT、APTT分别长于本组治疗前，t-PA分别高于本组治疗前，PAI-1分别低于本组治疗前（P＜0.05）；治疗后，研究组PT、APTT长于对照组，t-PA高于对照组，PAI-1低于对照组（P＜0.05）。术后1 d，研究组颅内出血发生率低于对照组（P＞0.05）。术后3个月，两组责任血管再闭塞发生率、死亡率比较，差异无统计学意义（P＞0.05）。结论　与静脉溶栓治疗后颈内动脉支架植入术相比，颅内动脉机械取栓后颈内动脉支架植入术能有效提高颈内动脉串联病变所致脑卒中患者临床疗效、血管再通率，改善患者神经功能、日常生活活动能力及凝血功能，且可以降低患者颅内出血发生率。

Abstract：

Objective To observe the clinical efficacy of internal carotid artery stent implantation after mechanicalthrombectomy of intracranial artery in the treatment of patients with stroke caused by internal carotid artery tandem lesion.Methods A total of 98 patients with stroke caused by internal carotid artery tandem lesion who were treated in Huangshi CentralHospital from 2019 to 2022 were selected and divided into control group and study group by random number table method, with 49cases in each group. The patients in the control group were treated with internal carotid artery stent implantation after intravenousthrombolysis, and the patients in the study group were treated with internal carotid artery stent implantation after mechanicalthrombectomy of intracranial artery. The clinical efficacy, TIMI blood flow grading, National Institutes of Health Stroke Scale(NIHSS) score, modified Rankin Scale (mRS) score, Brathel index and coagulation function indexes [prothrombin time (PT) ,activated partial thromboplastin time (APTT) , tissue plasminogen activator (t-PA) , plasminogen activator inhibitor-1 (PAI-1) ]before and after treatment were compared between the two groups. The incidence of intracranial hemorrhage at 1 day afteroperation, and the incidence of reocclusion of responsible vessels and mortality at 3 months after operation of the groups wererecorded. Results The clinical efficacy and TIMI blood flow grading in the study group were better than those in the controlgroup (P < 0.05) . After treatment, the NIHSS score and mRS score in the two groups were lower than those before treatmentrespectively, the Barthel index was higher than that before treatment respectively, the NIHSS score and mRS score in the studygroup were lower than those in the control group, and the Barthel index was higher than that in the control group (P < 0.05) . After treatment, PT and APTT in the two groups were longer than those before treatment, t-PA was higher than that before treatment,and PAI-1 was lower than that before treatment, respectively (P < 0.05) . After treatment, PT and APTT in the study group werelonger than those in the control group, t-PA was higher than that in the control group, and PAI-1 was lower than that in thecontrol group (P < 0.05) . At 1 day after operation, the incidence of intracranial hemorrhage in the study group was lower than thatin the control group (P > 0.05) . At 3 months after operation, there was no significant difference in the incidence of reocclusionof responsible blood vessels and mortality between the two groups (P > 0.05) . Conclusion Compared with the internalcarotid artery stent implantation after intravenous thrombolysis, the internal carotid artery stent implantation after mechanicalthrombectomy of intracranial artery can effectively improve the clinical efficacy, vascular recanalization rate, neurologicalfunction, activities of daily living and coagulation function of patients with stroke caused by internal carotid artery tandem lesion,and reduce the incidence of intracranial hemorrhage of patients.

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