[Efficacy comparison of three vascular recanalization in patients with acute vertebrobasilar occlusion].

Objectives: To investigate the therapeutic effects of intravenous thrombolysis, intra-artery thrombolysis, mechanical thrombectomy on patients with acute vertebrobasilar occlusion. Methods: Retrospective analysis of clinical data of patients with acute vertebrobasilar occlusion, admitted to Huai'an First People's Hospital and Bingtuan Qishi Hospital from January 2014 to January 2016, was performed. According to different vascular recanalization, these patients were divided into intravenous thrombolysis group, intra-artery thrombolysis group and mechanical thrombectomy group. Clinical outcomes were compared among the three groups such as recanalization rates( modified thrombolysis in cerebral infarction[mTICI]≥2b), changes of NIHSS scores after 24 hours(scores decreased at least 4 points or complete resolution of symptoms), symptomatic cerebral hemorrhage rate(European Cooperative Acute Stroke Study Ⅱ standard) and modified Rankin scale(mRS) score improvement 3 months after treatment. Results: Among patients from mechanical thrombectomy group, the recanalization rate was 87.5%(28/32), 22 patients(68.8%)got good outcome according to the significant decrease of NIHSS scores, symptomatic intracranial hemorrhage occurred in 3 patient (9.4%), the rate of good prognosis(mRS≤2) at 3 months was 50.0% (16/32). In patients from intravenous thrombolysis group, the rate of recanalization was 34.8% (16/46), 12 patients(26.1%)got apparent decrease of NIHSS scores, symptomatic cerebral hemorrhage occurred in 14 patients(30.4%), the rate of good clinical outcome(mRS ≤2) at 3 months was 17.4%(8/46). Among patients from intra-arterial thrombolysis group, the recanalization rate was 53.3%(16/30), 12 patients(40.0%) got good outcome according to the significant decrease in NIHSS score, symptomatic intracranial hemorrhage occurred in 6 patients(20.0%), the rate of good prognosis(mRS≤2) at 3 months was 26.7%(8/30). The rate of complete recanalization and NIHSS score improvement at 24 hours were significantly higher in the mechanical thrombectomy group than the intravenous or intra-arterial thrombolysis group(χ(2)=21.324, P<0.001; χ(2)=14.162, P=0.001). The good outcome(mRS≤2) at 3 months was more frequent in the mechanical thrombectomy group than the intravenous or intra-arterial thrombolysis group (χ(2)=9.799, P=0.007). The differences of symptomatic intracranial hemorrhage rate among the three treatment groups were not statistically significant(χ(2)=5.035, P=0.081). Conclusion: As compared with the intravenous or intra-arterial thrombolysis, the mechanical thrombectomy has better efficiency and safety in the treatment of acute vertebrobasilar occlusion.目的：比较急性椎基底动脉闭塞所致脑梗死患者行静脉溶栓、动脉溶栓及支架取栓的治疗效果差异。方法：回顾性分析在2014年1月至2016年1月期间在淮安市第一人民医院和兵团第七师医院神经科住院治疗的所有急性椎基底动脉闭塞患者的临床资料，依据血管开通方法的不同分为静脉溶栓组、动脉溶栓组和机械取栓组，评估不同方法治疗后血管再通率、美国国立卫生研究院卒中量表(NIHSS)评分改善率、症状性颅内出血发生率及90 d时改良Rankin评分(mRS)情况。结果：机械取栓组共有32例患者，其中有28例(87.5%)患者血管成功再通，有22例(68.8%)患者治疗后24 h NIHSS得分明显下降(≥4分)，16例(50.0%)患者3个月临床预后良好(mRS≤2分)；静脉溶栓组共有46例患者，其中16例(34.8%)患者血管成功再通，有12例(26.1%)患者溶栓后24 h NIHSS得分明显下降，8例(17.4%)患者3个月临床预后良好；动脉溶栓组共有30例患者，其中有16例(53.3%)患者血管成功再通，12例(40.0%)患者治疗24 h后NIHSS得分明显下降，8例(26.7%)患者3个月临床预后良好。机械取栓组发生了3例(9.4%)症状性颅内出血，静脉溶栓组发生了14例(30.4%)症状性颅内出血，动脉溶栓组发生了6例(20.0%)症状性颅内出血。机械取栓组血管再通率和24 h后NIHSS得分好转率均比静脉溶栓及动脉溶栓组高，差异有统计学意义(χ(2)＝21.324，P<0.001；χ(2)＝14.162, P＝0.001)。90 d临床预后良好率机械取栓组优于静脉溶栓和动脉溶栓组(χ(2)＝9.799, P＝0.007)。症状性颅内出血率3组之间差异无统计学意义(χ(2)＝5.035，P＝0.081)。结论：对于急性椎基底动脉闭塞性卒中患者，机械取栓能提高血管再通率，改善临床预后，是安全有效的。.