【摘要】 目的探讨机械再通治疗伴大动脉闭塞的醒后卒中的安全性及有效性。方法回顾性分析经动脉内机械取栓治疗颅内大血管急性闭塞患者的临床资料,根据最后获知健康时间至血管内治疗开始时间(T)将病例分为对照组(T≤6 h,48例)和醒后卒中组(WUS组,11例)。以Alberta卒中项目早期CT评分(ASPECTS)≥6分作为挑选醒后卒中患者进行血管内治疗的主要影像学标准。对比醒后卒中组与对照组患者的基线特征、血管开通效果、出血并发症发生情况和预后差异。结果 59例患者经脑血管造影(DSA)证实为颅内大动脉闭塞。WUS组术前NIHSS评分中位数为16(6～28)分;责任血管:颈内动脉2例、大脑中动脉6例、基底动脉2例、椎动脉1例。WUS组术后影像学检查发现1例患者存在无症状性脑出血,无症状性颅内出血,无死亡病例;患者出院时NIHSS评分中位数为8(2～30)分,同最初NIHSS评分相比,7例患者改善5分及以上。WUS组与对照组患者在年龄、性别比、NIHSS评分、ASPECT评分、责任血管分布方面均无明显差异;WUS组与对照组患者在再通率、90 d mRS评分、术后并发症方面均无明显差异。结论血管内机械取栓可使部分大动脉闭塞的醒后卒中患者获益。更多还原

【Abstract】 Objective To investigate the safety and effectiveness of endovascular mechanical recanalization for the treatment of wake-up stroke with intracranial large-vessel occlusion. Methods The clinical data of patients with acute intracranial large artery occlusion treated with endovascular mechanical recanalization were analyzed retrospectively. According to time from symptom onset to treatment( T),patients were allotted to two groups: control group( T≤6 h,n = 48) and wake-up stroke group( WUS group,n = 11). Alberta stroke Program Early CT Score( ASPECTS) ≥6 was used as the primary imaging criterion for offering thrombectomy in these WUS patients. The baseline characteristics,vascular recanalization,occurrence of symptomatic hemorrhage and clinicaloutcome of the WUS group and control group were analyzed. Results Fifty-nine patients were diagnosed with intracranial largevessel occlusion by digital subtraction angiography( DSA). In WUS group,the median NIHSS scores before procedure were 16( range 6 to 28); Two patients had internal carotid artery occlusions,four had middle cerebral artery occlusions,two had basilar artery occlusions,and one had vertebral artery occlusion. In WUS group,one patient had asymptomatic intracranial hemorrhage and no symptomatic intracranial hemorrhage or death case. The median NIHSS score at discharge was 8( range 2 to 30),the NIHSS scores improved ≥5 points in 7 cases compared with the initial NIHSS scores. There were no significant differences in baseline characteristics,recanalization rate,mRS scores at 90 days and postoperative complications between the two groups. Conclusions WUS patients with intracranial largevessel occlusion could benefit from mechanical recanalization therapy.更多还原