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中华脑血管病杂志(电子版) ›› 2023, Vol. 17 ›› Issue (02) : 107 -111. doi: 10.11817/j.issn.1673-9248.2023.02.005

临床研究

低NIHSS评分伴大血管闭塞性急性缺血性卒中机械取栓治疗效果分析
曹杨1, 张凯2, 张士永3,()   
  1. 1. 100015 首都医科大学附属北京地坛医院神经外科
    2. 100069 北京,首都医科大学神经内科学
    3. 100054 北京丰台右安门医院神经介入科
  • 收稿日期:2022-08-26 出版日期:2023-04-01
  • 通信作者: 张士永

Analysis of mechanical thrombectomy for acute ischemic strokes with low NIHSS scores and large vessel occlusion

Yang Cao1, Kai Zhang2, Shiyong Zhang3,()   

  1. 1. Neurology, Capital Medical University, Beijing 100069, China; Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
    2. Neurology, Capital Medical University, Beijing 100069, China
    3. Neurology, Capital Medical University, Beijing 100069, China; Department of Neurointervention, Beijing Fengtai You'anmen Hospital, Beijing 100054, China
  • Received:2022-08-26 Published:2023-04-01
  • Corresponding author: Shiyong Zhang
引用本文:

曹杨, 张凯, 张士永. 低NIHSS评分伴大血管闭塞性急性缺血性卒中机械取栓治疗效果分析[J/OL]. 中华脑血管病杂志(电子版), 2023, 17(02): 107-111.

Yang Cao, Kai Zhang, Shiyong Zhang. Analysis of mechanical thrombectomy for acute ischemic strokes with low NIHSS scores and large vessel occlusion[J/OL]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2023, 17(02): 107-111.

目的

分析低美国国立卫生研究院卒中量表(NIHSS)评分伴大血管闭塞性急性缺血性卒中患者机械取栓的治疗效果。

方法

收集2020年1月至2022年6月右安门医院神经介入科收治的急性缺血性卒中机械取栓患者的临床资料,其中25例患者表现为低NIHSS评分伴大血管闭塞,回顾性分析并总结此类患者的临床特点,采用Wilcoxon秩和检验分别比较基线NIHSS评分与术后24 h及90 d NIHSS评分的差异。

结果

25例患者中男性19例(76.0%),年龄为(61±13)岁,高血压为常见合并症(56.0%,14/25),Alberta卒中项目早期CT评分为10分者占56.0%(14/25),病因分型以大动脉粥样硬化型为主(84.0%,21/25),成功开通22例(88.0%,22/25),颅内无症状出血2例(8.0%,2/25),90 d NIHSS评分低于基线NIHSS评分[1(0,2)分 vs 4(3,4)分],差异具有统计学意义(Z=-2.335,P=0.020),90 d随访良好预后率为92.0%(23/25)。

结论

机械取栓手术作为低NIHSS评分伴大血管闭塞性急性缺血性卒中患者的治疗方案是可行的,并且有较高的安全性及血管再通率。

Objective

To analyze the therapeutic effect of mechanical thrombectomy in patients with acute ischemic strokes with low National Institute of Health stroke scale (NIHSS) scores and large vessel occlusions.

Methods

The clinical data of acute ischemic stroke patients with mechanical thrombectomy admitted to the Neurointerventional Department of You'anmen Hospital from January 2020 to June 2022 were collected. Among them, 25 patients presented with low NIHSS scores and large vessel occlusions. The clinical characteristics of these patients were retrospectively analyzed and summarized. Wilcoxon rank-sum test was used to compare the difference between baseline NIHSS scores and postoperative NIHSS scores at 24 hours and 90 days after the operation.

Results

Among the 25 patients, 19 were male (76.0%), aged (61±13) years. Hypertension was a common comorbidity (56.0%, 14/25). Patients with Alberta stroke program early CT score 10 accounted for 56.0% (14/25). The main etiological type was large-artery atherosclerosis (84.0%, 21/25). 22 patients (88.0%, 22/25) were successfully recanalized and 2 patients (8.0%, 2/25) had asymptomatic intracranial hemorrhage. The NIHSS score at 90 days was lower than the baseline NIHSS score [1 (0, 2) score vs 4 (3, 4) score], with a statistically significant difference (Z=-2.335, P=0.020). The good prognosis rate was 92.0% (23/25) at 90 days follow-up.

Conclusion

Mechanical thrombectomy is feasible as a treatment for patients with low NIHSS scores and large vessel occlusions, and has high safety and vessel recanalization rate.

表1 25例大血管闭塞性急性缺血性卒中患者基线临床资料和手术情况
项目 数据 项目 数据
年龄(岁,
x¯
±s
61±13 受累动脉系统[例(%)]
男性[例(%)] 19(76.0) 左颈内动脉 5(20.0)
高血压[例(%)] 14(56.0) 右颈内动脉 12(48.0)
高脂血症[例(%)] 9(36.0) 椎基底动脉 8(32.0)
糖尿病[例(%)] 10(40.0) 桥接治疗[例(%)] 5(20.0)
既往脑梗死[例(%)] 6(24.0) 手术时间[min,MQR)] 45.0(33.0,55.0)
心房纤颤[例(%)] 2(8.0) 取栓次数(次,
x¯
±s
1.4±0.6
吸烟[例(%)] 11(44.0) DPT[min,MQR)] 55.0(30.0,154.0)
TOAST病因分型[例(%)] PRT(min,
x¯
±s
43.9±16.8
大动脉粥样硬化型 21(84.0) 手术方式[例(%)]
心源性栓塞 2(8.0) 支架取栓 16(64.0)
小动脉闭塞 0(0) 抽吸取栓 6(24.0)
其他明确病因 1(4.0) 支架+抽吸取栓 3(12.0)
不明原因 1(4.0) 术后出血[例(%)] 2(8.0)
基线NIHS评分[例(%)] 侧支状态[例(%)]
0分 0(0) 代偿良好 22(88.0)
1分 2(8.0) 代偿不足 3(12.0)
2分 4(16.0) 术后mTICI分级[例(%)]
3分 6(24.0) ≥2b级 22(88.0)
4分 8(32.0) <2b级 3(12.0)
5分 5(20.0) 90 d mRS评分[例(%)]
基线NIHSS[分,MQR)] 4(3,4) 0分 11(44.0)
24 h NIHSS[分,MQR)] 3(2,4) 1分 8(32.0)
90 d NIHSS[分,MQR)] 1(0,2) 2分 4(16.0)
术前CT(%) 25(100.0) 3分 1(4.0)
ASPECT评分[例(%)] 4分 1(4.0)
7分 2(8.0) 5分 0(0)
8分 4(16.0) 6分 0(0)
9分 5(22.0)
10分 14(56.0)
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