【摘要】 目的 分析直接抽吸取栓（DA）与支架取栓（SR）治疗后循环急性缺血性卒中患者的有效性与安全性。方法 选取2024年1月—2025年2月在河南医药大学南阳市中心医院就诊的138例急性后循环大血管闭塞患者为研究对象，通过随机分组法分为DA组（n=70）和SR组（n=68）。DA组采用大口径抽吸导管直接接触血栓实施负压抽吸，操作不联用支架取栓；SR组采用可回收支架跨越闭塞段取栓，操作不联用直接抽吸取栓。将改良脑梗死溶栓分级（mTICI）≥2b级定义为血管再通，治疗后90 d改良Rankin量表（mRS）评分>2分为预后不良，≤2分为预后良好。比较两组患者穿刺至血管再通时间、血管再通分级、预后良好率、并发症发生情况、治疗后90 d病死率、治疗前后美国国立卫生研究院卒中评分（NIHSS）和格拉斯哥昏迷评分法（GCS）评分及差值。结果 138例患者中，DA组血管再通率为88.6%(62/70)，高于SR组的85.3%(58/68)，组间比较差异无统计学意义（P>0.05）。DA组治疗后90 d的预后良好率为51.4%(36/70)，高于SR组的48.5%(33/68)，组间比较差异无统计学意义（P>0.05）。DA组穿刺至血管再通时间为（56.9±3.9）min，短于SR组的（61.1±5.3）min，组间比较差异有统计学意义（t=4.582,P<0.05）。两组患者术后出血转化发生情况、症状性颅内出血发生情况、治疗前后NIHSS评分及差值、治疗前后GCS评分及差值和治疗后90 d病死率比较，差异均无统计学意义（均P>0.05）。结论 DA和SR治疗急性后循环大血管闭塞脑梗死患者的疗效相似，前者可缩短血管再通时间。更多还原

【Abstract】 Objective To analyze the efficacy and safety of direct aspiration thrombectomy(DA) and stent retriever thrombectomy(SR) in patients with posterior circulation acute ischemic stroke. Methods From January 2024 to February 2025, 138 patients with acute posterior circulatory large vessel occlusion admitted to Nanyang Central Hospital, Henan Medical University were selected as study subjects. Patients were randomly divided into DA group(70 cases) and SR group(68 cases) using the simple randomization. DA group used a large-diameter aspiration catheter to directly contact the thrombus for negative pressure suction, without using SR. SR group used a retrievable stent to bypass the occluded segment and remove the thrombus, without using DA. Vascular recanalization was defined as a modified Thrombolysis in Cerebral Infarction(mTICI) score of ≥ 2b. A modified Rankin Scale(mRS) score of > 2 90 days after treatment indicated a poor prognosis, while a score of ≤ 2 indicated a good prognosis. Two groups of patients were compared in terms of puncture to vascular recanalization time, vascular recanalization grade, good prognosis rate, incidence of complications, 90-day mortality after treatment, National Institutes of Health Stroke Scale(NIHSS) and Glasgow Coma Scale(GCS) scores before and after treatment, and their differences. Results Among 138 patients, the vascular recanalization rate in DA group was 88.6%(62/70), which was higher than 85.3%(58/68) in SR group, and the difference was not statistically significant(P>0.05). The good prognosis rate of DA group after 90 days of treatment was 51.4%(36/70), which was higher than 48.5%(33/68) of SR group, and the difference was not statistically significant(P>0.05). The time from puncture to vascular recanalization in DA group was(56.9±3.9) min, which was shorter than that in SR group(61.1±5.3) min, and the difference was statistically significant(t=4.582,P<0.05). There were no statistically significant differences between the two groups in terms of postoperative hemorrhagic transformation, symptomatic intracranial hemorrhage, NIHSS score and differences before and after treatment, GCS scores and differences before and after treatment, or 90-day mortality following treatment(all P > 0.05). Conclusions DA and SR are equally effective in treating patients with posterior circulation large vessel occlusion, with the former shortening the time for vascular recanalization.更多还原