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目的比较因静脉溶栓(IVT)不成功或有IVT禁忌证无法血运重建的病人使用支架进行动脉血管成形术的安全性及实用性。材料与方法病例对照研究获得当地伦理委员会批准;所有病人签署知情同意书。131例因大脑中动脉(MCA)闭塞的急性缺血性脑卒中(AIS)病人,其中男性74例,年龄25～86岁,平均(65.9±12.3)岁。75例接受了IVT治疗。在MCA行IVT的病人中有26例(35%)未进行进一步的血管再通治疗(组1)。IVT治疗失败后60min行血管内治疗(组2A)或未经进一步治疗(组2B)。AIS发病8h内病人因IVT禁忌证需血管内治疗(组3A)或无再通治疗(组3B)。入院时的神经损伤、MCA再通、症状性颅内出血(SICH)及3个月后的临床结果都被评估。根据修订后的Rankin评分,脑卒中发病3个月后得分在0~2分间定义为满意的结果。双侧Mann-WhitneyU检验、独立样本t检验、Fisher精确检验、基线变量多因素统计回归分析,以及MCA血管完全再通作为满意结果预测都被用于统计评估。结果入院时各组(1、2A、2B、3A、3B)国家脑卒中评分中位数分别为13.5、16.0、15.5、15.0和16.0(P>0.05);SICH发生在各组的概率分别为1/26(3.8%)、1/23(4.3%)、1/26(3.8%)、1/31(3.2%)和1/25(4.0%),P>0.05。50/54例经血管内介入治疗后MCA再通(92.6%)。2A组(10/23,占43.5%)与2B组(4/26,占15.4%)间结果满意,P=0.03;3A组(14/31,占45.2%)与3B组(2/25,占8%)间结果差异有统计学意义,P=0.004;依赖MCA的再通(优势比为5.55;P=0.006)。结论本对照试验研究显示对因急性大脑中动脉闭塞伴有IVT禁忌证或IVT不成功病人,使用支架进行动脉血管重建术是一种安全有效的治疗方法。
Objective To compare the safety and usefulness of using angioplasty for angioplasty in patients with unsuccessful revascularization due to unsuccessful intravenous thrombolysis (IVT) or IVT contraindications. Materials and Methods Case-control studies were approved by the local ethics committee; all patients signed informed consent. Of 131 patients with acute ischemic stroke (AIS) who had occlusion of the middle cerebral artery (MCA), 74 were males, ranging in age from 25 to 86 years (mean, 65.9 ± 12.3 years). 75 patients received IVT treatment. Twenty-six (35%) of the patients with IVT in the MCA did not undergo further revascularization (Group 1). Endovascular treatment at 60 min after IVT failure (group 2A) or without further treatment (group 2B). Patients requiring IVT contraindications were treated with endovascular therapy (group 3A) or without reperfusion (group 3B) within 8 h of AIS. Nerve injury at admission, MCA recanalization, symptomatic intracranial hemorrhage (SICH), and clinical outcomes after 3 months were evaluated. According to the revised Rankin score, scores of 3 months after the onset of stroke were defined as satisfactory results between 0 and 2 points. Two-sided Mann-Whitney U test, independent sample t-test, Fisher’s exact test, multivariate statistical regression analysis of baseline variables, and complete recanalization of MCA as predictive outcome were used for statistical evaluation. Results The median scores of stroke in each group (1, 2A, 2B, 3A, 3B) were 13.5,16.0,15.5,15.0 and 16.0 (P> 0.05) at admission, respectively. The incidence of SICH in each group was 1 /26(3.8%),1/23 (4.3%), 1/26 (3.8%), 1/31 (3.2%) and 1/25 (4.0%), P> 0.05.50 / 54 cases MCA recanalization after interventional therapy (92.6%). The results were satisfactory in group 2A (10/23, 43.5%) and group 2B (4/26, 15.4%), P = 0.03; in group 3A (14/31, 45.2% Accounting for 8%), the difference was statistically significant (P = 0.004); MCA-dependent recanalization (odds ratio 5.55; P = 0.006). CONCLUSIONS: This controlled trial has shown that the use of stents for arterial revascularization is a safe and effective treatment for patients with acute middle cerebral artery occlusion with IVT contraindications or unsuccessful IVT.