Zhongguo cuzhong zazhi (Oct 2023)

后循环急性大血管闭塞性卒中的血管内治疗：单中心病例系列报道 Endovascular Treatment for Acute Posterior Circulation Stroke with Large Vessel Occlusion: A Single-center Case Series Report

  • 尹梦鑫，张舒婷，任伟超，王铁军，段春苗

DOI
https://doi.org/10.3969/j.issn.1673-5765.2023.10.005
Journal volume & issue
Vol. 18, no. 10
pp. 1129 – 1135

Abstract

Read online

目的 评估后循环急性大血管闭塞性卒中血管内治疗（endovascular treatment，EVT）的安全性和有效性。 方法 回顾性连续入组2020年9月—2023年3月在北京市大兴区人民医院接受急诊EVT的发病72 h内的后循环急性大血管闭塞性卒中住院患者。收集患者的人口学信息、既往史、基线血压、TOAST分型、入院及术前NIHSS评分、发病至治疗时间及院内治疗信息等资料。疗效结局包括术后mTICI分级（将2b/3级定义为血管再通）、术后24 h和出院时NIHSS评分及出院时mRS评分（0～3分定义为预后良好）。安全性结局采用发病36 h内症状性颅内出血发生率及住院期间死亡率。 结果 共纳入26例接受急诊EVT的后循环急性大血管闭塞性卒中患者（静脉溶栓桥接EVT组7例，直接EVT组19例），其中男性16例（62%），女性10例（38%），年龄（64.2±11.1）岁。25例（96%）患者术后血管成功再通，术后24 h NIHSS评分为8.0（3.0～14.0）分[静脉溶栓桥接EVT组3.0（2.0～12.5）分；直接EVT组8.0（4.3～16.3）分]。共16例（62%）患者出院时获得良好预后，3例（12%）患者发生死亡，所有患者均未发生症状性颅内出血。 结论 EVT能够有效实现后循环急性大血管闭塞性卒中的血管再灌注，安全性良好 Abstract: Objective To evaluate the safety and effectiveness of endovascular treatment (EVT) for acute posterior circulation stroke with large vessel occlusion. Methods Patients within 72 hours with acute posterior circulation stroke due to large vessel occlusion who underwent emergency EVT in Beijing Daxing District People's Hospital from September 2020 to March 2023 were included. Demographic information, past history, baseline blood pressure, TOAST classification, admission and preoperative NIHSS score, onset to treatment time and in-hospital treatment information were collected. The effectiveness outcome included postoperative mTICI grading (defined as vascular recanalization at 2b/3), NIHSS score at 24 h after surgery and at discharge, mRS score at discharge (0 to 3 scores defined as good prognosis). The safety outcome included the incidence of symptomatic intracranial hemorrhage (sICH) within 36 h and mortality during hospitalization. Results A total of 26 patients with acute posterior circulation stroke with large vessel occlusion were included (7 patients in the intravenous thrombolysis bridging EVT group and 19 in direct EVT group). 16 patients (62%) were male, and 10 patients (38%) were female. The mean age was (64.2±11.1) years old. Successful recanalization was observed in 25 patients (96%). The 24 h-NIHSS score at postoperation was 8.0(3.0-14.0) [the intravenous thrombolysis bridging EVT group 3.0(2.0-12.5) versus direct EVT group 8.0(4.3-16.3)]. 16 patients (62%) had good prognoses at discharge. 3 patients (12%) died, and no sICH occurred. Conclusions EVT could effectively achieve successful reperfusion in acute posterior circulation stroke with large vessel occlusion, which showed good security.

Keywords