[1]陆小小,许 磊,苏浩波,等.急性缺血性脑卒中桥接治疗临床效果及预后影响因素探讨[J].介入放射学杂志,2021,30(06):595-599.
　LU Xiaoxiao,XU Lei,SU Haobo,et al.The curative effect of bridging therapy for acute ischemic stroke and the discussion on the prognostic factors[J].journal interventional radiology,2021,30(06):595-599.
点击复制

急性缺血性脑卒中桥接治疗临床效果及预后影响因素探讨()

PDF下载中关闭

分享到：

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
30
期数:
2021年06
页码:
595-599
栏目:
临床研究
出版日期:
2021-06-26

文章信息/Info

Title:
The curative effect of bridging therapy for acute ischemic stroke and the discussion on the prognostic factors
作者:
陆小小;  许 磊;  苏浩波;  赵伯翔;  顾建平;  缪正飞
Author(s):
LU Xiaoxiao;  XU Lei;  SU Haobo;  ZHAO Boxiang;  GU Jianping;  MIAO Zhenfei.
Department of Oncology， Lianyungang Municipal Second People’s Hospital， Lianyungang， Jiangsu Province 222023， China
关键词:
【关键词】 急性缺血性脑卒中;  血管内取栓术;  静脉溶栓;  预后
文献标志码:
A
摘要:
【摘要】 目的 探讨急性大动脉缺血性脑卒中静脉溶栓（IVT）后血管内取栓术（EVT）治疗（桥接治疗）的临床效果及预后影响因素。方法 回顾性分析2017年1月至2019年9月南京市第一医院收治的135例急性缺血性脑卒中患者临床资料。根据治疗方法分为桥接治疗组（n=64）和单纯EVT治疗组（n=71）。根据改良溶栓治疗脑梗死（mTICI）血流分级比较两组患者血管再通率，改良Rankin量表（mRS）评分比较预后。多因素logistic回归法分析桥接治疗预后影响因素。结果 桥接治疗组与单纯EVT治疗组相比，侧支循环更丰富[美国介入和治疗神经放射学会（ASITN）分级3.13±0.54对2.27±1.22，t=4.463，P=0.035]；治疗后血管再通成功率（mTICI血流分级2b～3级）稍高（67.2%对52.1%）、出血转化比例稍高（42.2%对40.9%），但差异均无统计学意义（P＞0.05）。桥接治疗组出院mRS评分0～2分比例（54.69%对36.62%，χ2=4.436，P=0.039）、3个月mRS评分0～2分比例（64.06%对43.66%，χ2=5.628，P=0.025）显著高于单纯EVT治疗组。多因素logistic回归分析显示，入院DWI梗死体积（OR=0.723，95%CI=0.254～1.698，P=0.032）、侧支循环（OR=6.062，95%CI=1.563～26.971，P=0.012）、血管再通程度（OR=0.091，95%CI=0.024～0.489，P=0.035）和EVT术前IVT（OR=9.514，95%CI=1.832～35.245，P=0.008）是急性缺血性脑卒中患者预后的独立影响因素。结论 EVT术前IVT可改善急性缺血性脑卒中患者预后。综合评估入院DWI梗死体积、侧支循环、血管再通程度及是否行IVT有助于预测EVT治疗预后，指导临床康复治疗。

参考文献/References:

［1］ Pan X， Liu G， Wu B， et al. Comparative efficacy and safety of bridging strategies with direct mechanical thrombectomy in large vessel occlusion： a systematic review and meta- analysis［J］. Medicine， 2019， 98： e14956.
［2］ 杨建道，周永明，孟令磊，等． 静脉溶栓桥接机械取栓治疗急性脑梗死临床效果［J］． 介入放射学杂志， 2019， 28：786- 789．
［3］ 黄文立，宫淑杰，吴志生，等． 急性脑梗死合并前循环大血管闭塞患者桥接治疗和机械取栓临床效果分析［J］． 中风与神经疾病杂志， 2019， 36：147- 149．
［4］ 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018［J］． 中华神经科杂志， 2018， 51：666- 682．
［5］ von Kummer R， Broderick JP， Campbell BC， et al. The Heidelberg bleeding classification： classification of bleeding events after ischemic stroke and reperfusion therapy［J］. Stroke， 2015， 46： 2981- 2986.
［6］ Albers GW， Marks MP， Kemp S， et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging［J］. N Engl J Med， 2018， 378： 708- 718.
［7］ Bracard S， Ducrocq X， Mas JL， et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke （THRACE）： a randomised controlled trial［J］. Lancet Neurol， 2016， 15： 1138- 1147.
［8］ van den Berg LA， Dijkgraaf MG， Berkhemer OA， et al. Two- year outcome after endovascular treatment for acute ischemic stroke［J］. N Engl J Med， 2017， 376： 1341- 1349.
［9］ Esilles JP， Loyau S， Syvannarath V， et al. Alteplase reduces downstream microvascular thrombosis and improves the benefit of large artery recanalization in stroke［J］. Stroke， 2015， 46： 3241- 3248.
［10］ Guedin P， Larcher A， Decroix JP， et al. Prior IV thrombolysis facilitates mechanical thrombectomy in acute ischemic stroke［J］. J Stroke Cerebrovasc Dis， 2015， 24： 952- 957.
［11］ Katsanos AH， Malhotra K， Goyal N， et al. Intravenous thrombolysis prior to mechanical thrombectomy in large vessel occlusions［J］. Ann Neurol， 2019， 86： 395- 406.
［12］ Behme D， Kabbasch C， Kowoll A， et al. Intravenous thrombolysis facilitates successful recanalization with stent- retriever mechanical thrombectomy in middle cerebral artery occlusions［J］. J Stroke Cerebrovasc Dis， 2016， 25： 954- 959.
［13］ Merlino G， Sponza M， Petralia B， et al. Short and long- term outcomes after combined intravenous thrombolysis and mechanical thrombectomy versus direct mechanical thrombectomy： a prospec-tive single- center study［J］. J Thromb Thrombolysis， 2017， 44： 203- 209.
［14］ Abilleira S， Ribera A， Cardona P， et al. Outcomes after direct thrombectomy or combined intravenous and endovascular treatment are not different［J］. Stroke， 2017， 48： 375- 378.
［15］ Broeg- Morvay A， Mordasini P， Bernasconi C， et al. Direct mechanical intervention versus combined intravenous and mecha-nical intervention in large artery anterior circulation stroke： a matched- pairs analysis［J］. Stroke， 2016， 47： 1037- 1044.
［16］ Yoo AJ， Chaudhry ZA， Nogueira RG， et al. Infarct volume is a pivotal biomarker after intra- arterial stroke therapy［J］. Stroke， 2012， 43： 1323- 1330.
［17］ Lansberg MG， Straka M， Kemp S， et al. MRI profile and response to endovascular reperfusion after stroke（DEFUSE 2）： a prospective cohort study［J］. Lancet Neurol， 2012， 11： 860- 867.
［18］ Ribo M， Tomasello A， Lemus M， et al. Maximal admission core lesion compatible with favorable outcome in acute stroke patients undergoing endovascular procedures［J］. Stroke， 2015， 46： 2849- 2852.
［19］ Piedade GS， Schirmer CM， Goren O， et al. Cerebral collateral circulation： a review in the context of ischemic stroke and mechanical thrombectomy［J］. World Neurosurg， 2019， 122： 33- 42.
［20］ Goyal N， Tsivgoulis G， Frei D， et al. Comparative safety and efficacy of modified TICI 2b and TICI 3 reperfusion in acute ischemic strokes treated with mechanical thrombectomy［J］. Neurosurgery， 2018， 83： 593.

相似文献/References:

[1]王慧晓,徐永康,张剑平,等. 机械辅助动脉内溶栓治疗急性缺血性脑卒中[J].介入放射学杂志,2012,(08):664.
　WANG Wei- xiao,XU Yong- kang,ZHANG Jian- pin,et al. Mechanical auxiliary arterial thrombolytic therapy for the treatment of acute ischemic stroke[J].journal interventional radiology,2012,(06):664.
[2]张红梅,李天晓,蒯 洁,等. 采用Solitaire支架取栓术治疗急性缺血性脑卒中的手术配合[J].介入放射学杂志,2013,(10):868.
　ZHANG Hong? mei,LI Tian? xiao,KUAI Jie,et al. Nursing cooperation with the performance of Solitaire stenting removal of thrombus for the treatment of acute ischemic stroke[J].journal interventional radiology,2013,(06):868.
[3]周腾飞,朱良付,李天晓.影响急性缺血性脑卒中血管内治疗预后的相关因素分析[J].介入放射学杂志,2017,(02):99.
　ZHOU Tengfei,ZHU Liangfu,LI Tianxiao.Analysis of factors influencing the prognosis of patients with acute ischemic stroke receiving endovascular treatment[J].journal interventional radiology,2017,(06):99.
[4]许岗勤,王子亮,汪勇锋,等.导丝留置技术在急性脑动脉闭塞机械取栓中的应用[J].介入放射学杂志,2017,(03):202.
　XU Gangqin,WANG Ziliang,WANG Yongfeng,et al.The application of indwelling guide-wire technique in performing mechanical thrombectomy for acute cerebral artery occlusion[J].journal interventional radiology,2017,(06):202.
[5]蒋文贤,齐 立,唐永刚,等.颅内血栓抽吸系统联合可视性取栓支架治疗颅内大动脉急性梗死5例 [J].介入放射学杂志,2017,(11):971.
　JIANG Wenxian,QI Li,TANG Yonggang,et al.Intracanial thrombus suction combined with visible thrombectomy stent for the treatment of acute intracranial main artery infarction： preliminary results of 5 cases[J].journal interventional radiology,2017,(06):971.
[6]尚 凯,张晓星,魏小二,等.毛细血管指数评分在CTA评估急性缺血性脑卒中侧支循环和预后中的应用[J].介入放射学杂志,2019,28(10):930.
　SHANG Kai,ZHANG Xiaoxing,WEI Xiaoer,et al.The application of capillary index core in CTA evaluation of the collateral circulation and prognosis of acute ischemic stroke[J].journal interventional radiology,2019,28(06):930.
[7]刘强,王永利,王征宇,等.动静脉联合灌注替罗非班在非大血管闭塞急性缺血性脑卒中患者中的应用[J].介入放射学杂志,2019,28(12):1131.
　LIU Qiang,WANG Yongli,WANG Zhengyu,et al.The application of intravenous and intra- arterial combined perfusion of tirofiban in treating acute ischemic stroke patients with no large vessel occlusion[J].journal interventional radiology,2019,28(06):1131.
[8]邱 凯,施海彬,祖庆泉,等.急性缺血性脑卒中机械取栓后大面积脑梗死发生及其影响因素分析[J].介入放射学杂志,2020,29(12):1182.
　QIU Kai,SHI Haibin,ZU Qingquan,et al.The occurrence of large hemispheric infarction after endovascular thrombectomy for acute ischemic stroke and its influencing factors： a clinical analysis[J].journal interventional radiology,2020,29(06):1182.
[9]刘钦晨,贾振宇,赵林波,等.梗死核心容积预测急性前循环大血管闭塞患者机械取栓术后出血转化的价值[J].介入放射学杂志,2021,30(08):756.
　LIU Qinchen,JIA Zhenyu,ZHAO Linbo,et al.The clinical value of infarction core volume in predicting hemorrhagic transformation in patients with acute anterior circulatory large vessel occlusion after receiving mechanical thrombectomy[J].journal interventional radiology,2021,30(06):756.
[10]杭 宇,王绍显,贾振宇,等.对比剂连续应用对颅内大血管闭塞患者肾功能影响的前瞻性研究[J].介入放射学杂志,2021,30(11):1091.
　HANG Yu,WANG Shaoxian,JIA Zhenyu,et al.The effect of continuous use of iodinated contrast agent on the renal function in patients with occlusion of intracranial large artery： a prospective study[J].journal interventional radiology,2021,30(06):1091.

备注/Memo

备注/Memo:
（收稿日期：2020- 03- 25）
（本文编辑：边 佶）
更新日期/Last Update: 2021-06-25