目的 探讨早期神经功能恶化(early neurologic deterioration,END)的前循环大血管闭塞所致急性缺血性卒中(acute ischemic stroke,AIS)患者血管内治疗的有效性和安全性.方法 回顾性收集2019年6月至2023年4月期间在南京医科大学附属淮安第一医院神经内科因发生END在多模式影像指导下接受血管内治疗的前循环大血管闭塞所致AIS患者.应用改良脑梗死溶栓治疗(modified Thrombolysis in Cerebral Infarction,mTICI)分级评价血管再通状况,2b或3级定义为血管成功再通.发病后90 d时采用改良Rankin量表(modified Rankin Scale,mRS)评价功能转归,0～2分定义为转归良好.对发病至股动脉穿刺时间≤24h和＞24 h患者进行比较.结果 共纳入19例患者,男性13例,年龄(61.16±11.75)岁;中位基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分4分(四分位数间距2～5分),中位END时NIHSS评分13分(四分位数间距10～20分),12例(63.2％)在发生END前接受了静脉溶栓治疗;中位基线阿尔伯塔卒中项目早期CT评分8分(四分位数间距7～9分);血管成功再通18例(94.7％),2例(10.5％)发生有症状颅内出血(symptomatic intracranial hemorrhage,sICH);发病后 90 d 时 mRS 评分:0～2 分 12 例(63.2％),3分4例(21.1％),5分1例(5.2％),6分(死亡)2例(10.5％).发病至股动脉穿刺时间≤24h组10例(52.6％),＞24 h组9例(47.4％),两组仅基线阿尔伯塔卒中项目早期CT评分差异有统计学意义(P=0.035),但术后血管成功再通率、sICH发生率以及90 d时转归良好率均差异无统计学意义.结论 发生END的前循环大血管闭塞所致AIS患者在多模式影像指导下进行血管内治疗是安全可行的.
Endovascular therapy for patients with acute ischemic stroke due to anterior circulation large vessel occlusion with early neurological deterioration:a retrospective case series study
Objective To investigate the effectiveness and safety of endovascular therapy for patients with acute ischemic stroke(AIS)due to anterior circulation large vessel occlusion with early neurological deterioration(END).Methods Patients with AIS due to anterior circulation large vessel occlusion with END underwent endovascular therapy under the multimodal imaging guidance in the Department of Neurology,Huai'an First Hospital Affiliated to Nanjing Medical University from June 2019 to April 2023 were collected retrospectively.The modified Thrombolysis in Cerebral Infarction(mTICI)grading was used to evaluate the vascular recanalization,and grade 2b or 3 was defined as successful recanalization.At 90 days after onset,the modified Rankin Scale(mRS)was used to evaluate the functional outcome,and 0-2 was defined as a good outcome.The patients with onset to femoral artery puncture time ≤24 hours and＞24 hours were compared.Results A total of 19 patients were enrolled,including 13 males,aged 61.16±11.75 years.The median baseline National Institutes of Health Stroke Scale(NIHSS)score was 4(interquartile range,2-5),and the median NIHSS score at END was 13(interquartile range,10-20).Twelve patients(63.2％)received intravenous thrombolysis before END.Median baseline Alberta Stroke Project Early CT Score(ASPECTS)was 8(interquartile range,7-9);18 patients(94.7％)achieved successful recanalization,and 2(10.5％)experienced symptomatic intracranial hemorrhage(sICH).At 90 days after onset,the mRS scores:0-2 in 12 cases(63.2％),3 in 4 cases(21.1％),5 in 1 case(5.2％),and 6(death)in 2 cases(10.5％).There were 10 patients(52.6％)in the group with onset time to femoral artery puncture ≤24 hours,and 9 patients(47.4％)in the group with onset time＞24 hours.There was significant difference between the two groups only in the ASPECTS(P=0.035),but there were no significant differences in the postprocedural recanalization rate,sICH incidence rate,and good outcome rate at 90 days.Conclusion Endovascular therapy under the guidance of multimodal imaging is safe and feasible for AIS patients with END due to anterior circulation occlusion.
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