替奈普酶桥接血管内介入取栓与直接取栓治疗急性基底动脉闭塞性卒中的对比研究OA
Comparative study of tenecteplase-bridging endovascular thrombectomy versus direct thrombectomy in the treatment of acute basilar artery occlusion stroke
目的 观察替奈普酶桥接血管内介入取栓与直接取栓治疗急性基底动脉闭塞性卒中的临床疗效与安全性.方法 急性基底动脉闭塞性卒中患者,依据治疗方法的不同分为对照组和试验组.比较2组临床疗效、血管再通率、取栓相关指标、梗死灶相关参数、脑血流动力学指标、血清标志物、神经功能、90 d预后情况与不良反应情况的差异.结果 共纳入112例急性基底动脉闭塞性卒中患者,其中,对照组57例、试验组55例.治疗后,试验组总有效率为52.73％(29例/55例),高于对照组的33.33％(19例/57例)(P＜0.05).治疗即刻,试验组与对照组有效再通率分别为85.45％(47例/55例)和80.70％(46例/57例),完全再通率分别为56.36％(31例/55例)和49.12％(28例/57例),2组上述指标差异不具备统计学意义(P＞0.05).试验组与对照组首过效应(FPE)率分别为72.73％(40例/55例)和52.63％(30例/57例),取栓次数分别为(1.91±0.48)和(2.11±0.52)次,差异有统计学意义(P＜0.05);试验组与对照组取栓时间分别为(64.29±10.29)和(66.37±12.32)min,残余狭窄率分别为10.91％(6例/55例)和21.05％(12例/57例),差异无统计学意义(P＞0.05).术后24 h,试验组与对照组的缺血区体积分别为(82.66±15.21)和(93.61±18.65)mL,脑梗死核心区体积分别为(60.19±8.52)和(65.15±9.10)mL,缺血半暗带体积分别为(22.47±5.18)和(28.46±7.22)mL,最终梗死增长体积分别为(30.47±8.16)和(35.04±9.04)mL,缺血半暗带挽救率分别为(69.93±8.11)％和(64.71±7.52)％,收缩期峰值流速分别为(119.86±28.79)和(105.24±24.35)cm·s-1,舒张末期流速分别为(44.44±7.16)和(34.89±8.05)cm·s-1,阻力指数(RI)分别为 0.63±0.04 和 0.67±0.05,搏动指数(PI)分别为0.70±0.07和0.74±0.06,血清神经丝轻链蛋白(NfL)分别为(345.26±30.15)和(372.34±54.19)pg·mL-1,胶质纤维酸性蛋白(GFAP)分别为(526.37±74.91)和(566.42±82.21)pg·mL-1,2组上述指标比较差异有统计学意义(P＜0.05).术后7 d、30 d,试验组美国国立卫生研究院卒中量表(NIHSS)评分分别为(10.42±2.13)和(7.47±1.92)分,均低于对照组的(11.56±2.29)和(8.37±2.04)分;随访期间,试验组出现11例出血事件,包括4例症状性颅内出血(sICH)、6例非症状性颅内出血(aICH)、1例上消化道出血;对照组出现9例出血事件,包括4例sICH、5例aICH,差异无统计学意义(P＞0.05).试验组90 d预后良好率为54.55％(30例/55例),高于对照组的33.33％(19例/57例)(P＜0.05);2组全因死亡率与再梗死率无显著差异(P＞0.05).试验组与对照组总不良反应发生率分别为9.09％(5例/55例)和10.53％(6例/57例),组间比较差异无统计学意义(P＞0.05).结论 对于发病＜6h、ASA分级≤Ⅲ级、基线mRS 0～2分的急性基底动脉闭塞性卒中患者,替奈普酶桥接血管内介入取栓与直接取栓治疗急性基底动脉闭塞性脑卒中的血管再通效果接近,前者能减少取栓次数,进一步改善脑血流灌注,促进神经功能及预后改善,且安全性与直接取栓接近.
Objective To observe the clinical efficacy and safety of tenecteplase bridging endovascular thrombectomy versus direct thrombectomy in the treatment of acute basilar artery occlusion stroke.Methods Patients with acute basilar artery occlusion stroke were collected and divided into a control group and an experimental group based on different treatment methods.Compared the differences in clinical efficacy,vascular recanalization rate,thrombectomy-related indicators,infarct-related parameters,cerebral hemodynamic indicators,serum biomarkers,neurological function,90-day prognosis,and adverse reactions between the two groups.Results A total of 112 patients with acute basilar artery occlusion stroke were enrolled,including 57 cases in the control group and 55 cases in the experimental group.After treatment,the overall effective rate of the experimental group was 52.73％(29 cases/55 cases),which was higher than that of the control group 33.33％,(19 cases/57 cases)(P＜0.05).At the time of treatment,the effective recanalization rates in the experimental group and the control group were 85.45％(47 cases/55 cases)and 80.70％(46 cases/57 cases),respectively,while the complete recanalization rates were 56.36％(31 cases/55 cases)and 49.12％(28 cases/57 cases),respectively.There was no statistically significant difference in the above indicators between the two groups(P＞0.05).The first-pass effect(FPE)rates in the experimental group and the control group were 72.73％(40 cases/55 cases)and 52.63％(30 cases/57 cases),respectively,and the number of thrombectomy procedures was 1.91±0.48 and 2.11±0.52,respectively,with statistically significant differences(P＜0.05).The thrombectomy time in the experimental group and the control group was(64.29±10.29)and(66.37±12.32)min,respectively,and the residual stenosis rates were 10.91％(6 cases/55 cases)and 21.05％(12 cases/57 cases),respectively,with no statistically significant differences(P＞0.05).At 24 hours after the operation,the ischemic area volume of the experimental group and the control group was(82.66±15.21)and(93.61±18.65)mL.respectively,the ischemic core volume was(60.19±8.52)and(65.15±9.10)mL,respectively,the ischemic penumbra volume was(22.47±5.18)mL and(28.46±7.22)mL,respectively,the final infarct growth volume was(30.47±8.16)and(35.04±9.04)mL,respectively,the salvage rates of the ischemic penumbra were(69.93±8.11)％and(64.71±7.52)％,respectively,and the peak systolic velocity was(119.86±28.79)and(105.24±24.35)cm·s-1,respectively,the end-diastolic velocity was(44.44±7.16)and(34.89±8.05)cm·s-1,respectively;the resistance index(RI)was 0.63±0.04 and 0.67±0.05,respectively;the pulsatility index(PI)was 0.70±0.07 and 0.74±0.06,respectively;The serum neurofilament light chain(NfL)levels were(345.26±30.15)and(372.34±54.19)pg·mL-1,respectively,and the glial fibrillary acidic protein(GFAP)levels were(526.37±74.91)and(566.42±82.21)pg·mL-1,respectively.There were statistically significant differences in the above indicators between the two groups(P＜0.05).At 7 days,30 days postoperatively,the NIHSS scores of the experimental group were(10.42±2.13),(7.47±1.92)points,respectively,all of which were lower than those of the control group[(11.56±2.29),(8.37±2.04)points].During the follow-up period,11 bleeding events occurred in the experimental group,including 4 cases of symptomatic intracerebral hemorrhage(sICH),6 cases of asymptomatic intracerebral hemorrhage(aICH),and 1 case of upper gastrointestinal bleeding;9 bleeding events occurred in the control group,including 4 cases of sICH and 5 cases of aICH.The difference was not statistically significant(P＞0.05).The rate of favorable prognosis at 90 days was 54.55％(30 cases/55 cases)in the experimental group,which was higher than the 33.33％(19 cases/57 cases)in the control group(P＜0.05).There were no significant differences between the two groups in all-cause mortality or re-infarction rate(P＞0.05).The overall incidence of adverse reactions was 9.09％(5 cases/55 cases)in the experimental group and 10.53％(6 cases/57 cases)in the control group,with no statistically significant difference between the groups(P＞0.05).Conclusion For patients with acute basilar artery occlusion stroke with onset＜6 hours,ASA grade≤Ⅲ,and baseline mRS 0-2,tenecteplase bridging endovascular thrombectomy and direct thrombectomy achieve similar recanalization outcomes in the treatment of acute basilar artery occlusion stroke.The bridging approach reduces the number of thrombectomy attempts required,further improves cerebral blood flow perfusion,promotes neurological function and prognosis,while maintaining a safety profile comparable to that of direct thrombectomy.
夏玉蕊;王怡青;王慧敏
苏州大学附属第一医院,神经内科,江苏苏州 215000苏州大学附属第一医院,神经内科,江苏苏州 215000苏州大学附属第一医院,神经内科,江苏苏州 215000
医药卫生
急性基底动脉闭塞性卒中直接取栓替奈普酶桥接治疗血管再通
acute basilar artery occlusion strokedirect thrombectomytenecteplasebridging therapyvascular recanalization
《中国临床药理学杂志》 2026 (6)
776-783,8
评论