超高龄急性缺血性脑卒中病人行可回收支架机械取栓的效果及安全性

doi:10.3969/j.issn.1003-9198.2023.04.014

摘要/Abstract

摘要： 目的观察超高龄急性缺血性脑卒中病人行可回收支架机械取栓的效果及安全性。方法选择2018年6月至2020年12月本院收治的133例老年急性缺血性脑卒中病人为研究对象,根据年龄将≥90岁的病人作为超高龄组(47例),年龄＜90岁的病人作为老年组(86例)。所有病人均接受静脉溶栓和可回收支架机械取栓治疗。比较2组临床疗效、治疗不同时点中国脑卒中临床神经功能缺损量表(CSS)评分、取栓时间、取栓次数、是否植入支架、血管再通率、改良脑梗死溶栓(mTICI)分级、术后并发症发生情况及术后3个月内死亡率。结果 2组总有效率差异无统计学意义(74.47%比84.88%,P＞0.05)。治疗后3 d至4周,2组CSS评分均呈下降趋势(P＜0.05),但2组间差异均无统计学意义(P＞0.05)。2组血管再通率、mTICI分级差异无统计学意义(P＞0.05)。与老年组相比,超高龄组取栓时间较长、取栓次数较少、植入支架率较高(P＜0.05)。2组术后并发症总发生率差异无统计学意义(17.02%比11.63%,P＞0.05)。术后3个月内超高龄组死亡7例(14.89%),老年组死亡10例(11.63%),差异无统计学意义(P＞0.05)。结论超高龄急性缺血性脑卒中病人发病时也可接受可回收支架机械取栓治疗,不应只因年龄因素放弃治疗。

关键词: 急性缺血性脑卒中, 超高龄, 可回收支架, 机械取栓, 疗效, 安全性

Abstract: Objective To observe the effect and safety of mechanical thrombectomy with retrievable stent in the advanced aged patients with acute ischemic stroke. Methods A total of 133 elderly patients with acute inchemic stroke admitted to our hospital from June 2018 to December 2020 were selected as the research objects. According to the age, the patients aged≥90 years old were enrolled in the advanced aged group (47 cases) and the patients aged <90 years old were enrolled in the elderly group (86 cases). All the patients received intravenous thrombolysis and mechanical thrombectomy with retrievable stents. The clinical efficacy,the scores of Chinese Stroke Scale (CSS) at different treatment points,the time of thrombectomy, times of thrombectomy, stent implantation, vascular recanalization rate,the grade of modified thrombolysis in cerebral infarction (mTICI), the incidence rate of postoperative complications and the mortality rate in 3 months after operation were compared between the two groups. Results There was no significant difference in the total effective rate between the two groups(74.47% vs 84.88%, P>0.05). From 3 days to 4 weeks after treatment, CSS score showed a downward trend in both groups(P<0.05), but showing no significant differences between the two groups (P>0.05). There were no significant differences in vascular recanalization rate and the grade of mTICI between the two groups (P>0.05). Compared with the elderly group, the advanced aged group had longer thrombectomy time, fewer thrombectomy times and higher stent implantation rate (P<0.05). There was no significant difference in the incidence rate of postoperative complications between the two groups (P>0.05). Within 3 months after operation, 7 cases (14.89%) died in the advanced aged group, and 10 cases (11.63%) died in the elderly group. There was no significant difference in mortality between the two groups within 3 months after surgery (P>0.05). Conclusions The advanced aged patients with acute ischemic stroke can also undergo the treatment of mechanical thrombectomy with retrievable stent, and the treatment should not be abandoned just because of age.

Key words: acute ischemic stroke, advanced age, retrievable stent, mechanical thrombectomy, curative effect, security

中图分类号:

R 743.31

田伟, 杨章超, 马文群, 李霞, 王景梅, 武一平. 超高龄急性缺血性脑卒中病人行可回收支架机械取栓的效果及安全性[J]. 实用老年医学, 2023, 37(4): 378-381.

TIAN Wei, YANG Zhang-chao, MA Wen-qun, LI Xia, WANG Jing-mei, WU Yi-ping. Effect and safety of mechanical thrombectomy with retrievable stent in advanced aged patients with acute ischemic stroke[J]. Practical Geriatrics, 2023, 37(4): 378-381.

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