目的 探究Solitaire支架取栓结合静脉溶栓（IVT）对前循环急性缺血性脑卒中（CIS）患者预后及脑血流动力学状态、神经功能的影响。方法 回顾性分析2019年6月至2024年6月在我院接受治疗的122例CIS患者的临床资料,根据治疗方式不同分为两组：接受单纯IVT治疗的60例患者纳入对照组,接受Solitaire支架取栓结合IVT治疗的62例患者纳入治疗组。对比两组患者的血管再通情况及围术期并发症;比较治疗前后脑血流动力指标、血清神经因子、及神经功能评分。结果 治疗组血管再通率高于对照组,血管再通时间低于对照组,两组死亡率及并发症总发生率无显著性差异;两组术后24 h脑血流量（CBF）、平均流速（Vm）、动脉舒张末期流速（Vd）均高于术前,且治疗组高于对照组;两组术后72 h神经元特异性烯醇化酶（NSE）低于术前,且治疗组低于对照组,神经生长因子（NGF）、脑源性神经营养因子（BDNF）水平均高于术前,且治疗组高于对照组;出院时,治疗组两组患者美国国立卫生院卒中量表（NIHSS）评分均低于术前,且治疗组低于对照组;术后90 d,两组改良Rankin量表（mRS）评分均低于术前且治疗组低于对照组。结论 Solitaire支架取栓联合IVT治疗可显著提升CIS患者血管再通率、改善脑血流动力学状态、神经认知功能及脑神经保护因子水平,并且安全性较高。
Abstract
Objective To investigate the effects of Solitaire stent thrombectomy combined with intravenous thrombolysis (IVT) on the prognosis, cerebral hemodynamic status, and neurological function in patients with anterior circulation acute ischemic stroke (CIS). Methods The clinical data of 122 patients with CIS treated in our hospital from June 2019 to June 2024 were retrospectively analyzed. According to different treatment methods, the patients were divided into two groups: 60 patients who received IVT alone were included in the control group, and 62 patients who received Solitaire stent thrombectomy combined with IVT were included in the treatment group. Vascular recanalization status and perioperative complications were compared between the two groups. Cerebral hemodynamic indicators, serum nerve factors, and neurological function scores were compared before and after treatment. Results The vascular recanalization rate in the treatment group was higher than that in the control group, and the recanalization time was shorter than that in the control group. There was no significant difference in mortality and total incidence of complications between the two groups. At 24 hours after surgery, cerebral blood flow (CBF), mean velocity (Vm), and end-diastolic velocity (Vd) in both groups were higher than those before surgery, and those in the treatment group were significantly higher than the control group. At 72 hours after surgery, the levels of neuron-specific enolase (NSE) in both groups were lower than those before surgery, with the treatment group showing lower levels than the control group; the levels of nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) were higher than those before surgery, with the treatment group showing higher levels than the control group. At discharge, the National Institutes of Health Stroke Scale (NIHSS) scores in both groups were lower than those before surgery, and the score in the treatment group was lower than that in the control group. At 90 days after surgery, the modified Rankin Scale (mRS) scores in both groups were lower than those before surgery, and the score in the treatment group was lower than that in the control group. Conclusion Solitaire stent thrombectomy combined with IVT can significantly enhance the vascular recanalization rate, and improve the cerebral hemodynamic status, neurocognitive function and cerebral neuroprotective factors levels in patients with CIS, and it has high safety.
关键词
Solitaire支架 /
静脉溶栓 /
前循环急性缺血性脑卒中 /
血流动力学 /
神经功能
Key words
solitaire stent /
intravenous thrombolysis /
anterior circulation acute ischemic stroke /
neurological function
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基金
山东省医药卫生科技项目“转录组测序技术揭示缺血性脑卒中和动脉粥样硬化双疾病早期诊断标志物研究”（202403071080）
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