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血管内介入治疗急性缺血性脑卒中患者的短期和长期疗效。

The short- and long-term efficacies of endovascular interventions for the treatment of acute ischemic stroke patients.

作者信息

Yang Xingxiu, Jia Xiaohui, Ren Hua, Zhang Hongxing

机构信息

Department of Neurology, Nanchong Central Hospital Nanchong, Sichuan Province, China.

Department of Neurology, Xi'an Gaoxin Hospital, Affiliated to Northwest University Xi'an, Shaanxi Province, China.

出版信息

Am J Transl Res. 2021 May 15;13(5):5436-5443. eCollection 2021.

Abstract

OBJECTIVE

We aimed to investigate the short- and long-term efficacies of endovascular interventional therapy in acute ischemic stroke (AIS) patients.

METHODS

In this retrospective study, 94 patients with AIS were recruited and divided into a control group (n=51) that was administered intra-arterial thrombolysis and an observation group (n=43) that was administered Solitaire stent thrombectomies. The postoperative recanalization and overall response rates were recorded in both groups. The hemodynamic parameters (high shear viscosity, low shear viscosity, plasma viscosity, and hematocrit), and the C-reactive protein, interleukin 6, and fibrinogen levels were compared between the two groups before and after the treatment. In addition, the National Institutes of Health Stroke Scale and the modified Rankin Scale scores were analyzed before the treatment and at 1 and 3 months after the treatment in both groups. After a 3-year follow-up, a survival analysis was also performed using the Kaplan-Meier survival method.

RESULTS

The overall response and recanalization rates were higher in the observation group than they were in the control group (P<0.05). Before the treatment, there were no significant differences in the hemodynamic parameter, C-reactive protein, interleukin, 6 and fibrinogen levels in the two groups (P>0.05). After the treatment, the above levels in both groups decreased compared to their levels before the treatment, and the observation group had significantly lower levels than the control group (P<0.05). Moreover, no significant differences were seen in National Institutes of Health Stroke Scale and modified Rankin Scale scores between the two groups before the treatment (P>0.05). After the treatment, the above scores were decreased in both groups at 1 and 3 months compared to their pre-treatment levels, and the scores were significantly lower in the observation group than they were in the control group at 1 month after the treatment (P<0.05). After a 3-year follow-up, the Kaplan-Meier survival curves demonstrated that the survival times were significantly longer in the observation group than they were in the control group (P<0.05).

CONCLUSION

Solitaire stent thrombectomy markedly ameliorates neurological deficits in AIS patients, improves their recanalization rated, regulates the inflammatory response and hemodynamics in the lesion areas, thus exerting favorable short- and long-term clinical effects.

摘要

目的

我们旨在研究血管内介入治疗对急性缺血性卒中(AIS)患者的短期和长期疗效。

方法

在这项回顾性研究中,招募了94例AIS患者,分为接受动脉内溶栓治疗的对照组(n = 51)和接受Solitaire支架取栓术的观察组(n = 43)。记录两组术后再通率和总体有效率。比较两组治疗前后的血流动力学参数(高切变黏度、低切变黏度、血浆黏度和血细胞比容)以及C反应蛋白、白细胞介素6和纤维蛋白原水平。此外,分析两组治疗前以及治疗后1个月和3个月时的美国国立卫生研究院卒中量表(NIHSS)评分和改良Rankin量表评分。经过3年随访,还采用Kaplan-Meier生存法进行了生存分析。

结果

观察组的总体有效率和再通率高于对照组(P < 0.05)。治疗前,两组的血流动力学参数、C反应蛋白、白细胞介素6和纤维蛋白原水平无显著差异(P > 0.05)。治疗后,两组上述水平均较治疗前降低,且观察组显著低于对照组(P < 0.05)。此外,两组治疗前NIHSS评分和改良Rankin量表评分无显著差异(P > 0.05)。治疗后,两组在1个月和3个月时上述评分均较治疗前降低,且治疗后1个月时观察组评分显著低于对照组(P < 0.05)。经过3年随访,Kaplan-Meier生存曲线显示观察组的生存时间显著长于对照组(P < 0.05)。

结论

Solitaire支架取栓术可显著改善AIS患者的神经功能缺损,提高再通率,调节病变区域的炎症反应和血流动力学,从而产生良好的短期和长期临床效果。

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