《中国实用神经疾病杂志》官方网站
国际标准刊号(ISSN):1673-5110 国内统一刊号(CN):41-1381/R
您的位置:首页 > 论著

机械取栓与静脉溶栓治疗急性脑梗死临床分析

作者 / Author:李琳琳 杨清成△ 张建刚 郭艳平 李佳佳 王 禹

摘要 / Abstract:

目的 分析机械取栓、静脉溶栓及保守治疗急性脑梗死的临床效果、安全性及预后。方法 选择2016-06—2018-03安阳市人民医院治疗的101例急性脑梗死患者为研究对象,根据不同治疗方案分为A组(机械取栓组,35例)、B组(静脉溶栓组,34例)及C组(保守治疗组,32例)。使用美国国立卫生研究院卒中量表(NIHSS)评分及90 d改良Rankin量表(mRS),比较各组治疗前、治疗后即刻、治疗后 24 h、治疗后1周和2周的有效性及安全性。结果 治疗后2周,3组总体NIHSS评分显著下降(P<0.05

关键词 / KeyWords:

急性脑梗死,支架,机械取栓,静脉溶栓,血管内治疗,介入治疗,预后

机械取栓与静脉溶栓治疗急性脑梗死临床分析

李琳琳  杨清成  张建刚  郭艳平  李佳佳  王  禹
安阳市人民医院,河南 安阳 455000
基金项目:安阳市科技计划项目[社发(2016)27:0372192]
作者简介:李琳琳,Email:1149421323@qq.com
通信作者:杨清成,Email:ay03728378@163.com
摘要  目的  分析机械取栓、静脉溶栓及保守治疗急性脑梗死的临床效果、安全性及预后。方法  选择2016-06—2018-03安阳市人民医院治疗的101例急性脑梗死患者为研究对象,根据不同治疗方案分为A组(机械取栓组,35例)、B组(静脉溶栓组,34例)及C组(保守治疗组,32例)。使用美国国立卫生研究院卒中量表(NIHSS)评分及90 d改良Rankin量表(mRS),比较各组治疗前、治疗后即刻、治疗后 24 h、治疗后1周和2周的有效性及安全性。结果  治疗后2周,3组总体NIHSS评分显著下降(P<0.05),A、B组NIHSS评分明显低于C组,A组明显低于B组,差异均有统计学意义(P<0.05)。治疗后1周,3组颅内出血率、消化道出血率、病死率差异无统计学意义(P>0.05)。治疗后3个月,3组mRS≤2分者所占比例差异有统计学意义(P<0.05)。结论  机械取栓与静脉溶栓对大动脉急性脑梗死均有良好的临床疗效,且机械取栓较静脉溶栓安全性更高,远期预后良好。
关键词】  急性脑梗死;支架;机械取栓;静脉溶栓;血管内治疗;介入治疗;预后
中图分类号】  R743.33    【文献标识码】  A    【文章编号】  1673-5110(2018)21-2350-06  DOI:10.12083/SYSJ.2018.21.504
Clinical analysis of mechanical thrombectomy and intravenous thrombolysis for acute cerebral infarction
LI LinlinYANG QingchengZHANG JiangangGUO YanpingLI JiajiaWANG Yu
Anyang People's HospitalAnyang 455000,China
Abstract  Objective  To analyze the clinical efficacy,safety and prognosis of mechanical thrombectomy,intravenous thrombolysis and conservative treatment of acute cerebral infarction.Methods  101 patients with acute cerebral infarction treated by Anyang People's Hospital from 2016-06 to 2018-03 were selected as subjects.They were divided into group A (mechanical thrombectomy group,35 cases) and group B (venous thrombolysis according to different treatment options,34 patients) and group C(conservative treatment group,32 patients).Using the National Institutes of Health Stroke Scale (NIHSS) score and the 90-day modified Rankin Scale (mRS),Effectiveness and safetyof each group were compared before treatment,immediately after treatment,24 hours after treatment,1 week and2 weeks after treatment.Results  At 2 weeks after treatment,the overall NIHSS scores of the three groups decreased significantly (P<0.05).The NIHSS scores of group A and group B were significantly lower than group C,and those of group A were significantly lower than those of group B (P<0.05).One week after treatment,there was no significant difference in intracranial hemorrhage rate,gastrointestinal bleeding rate and mortality between the three groups (P>0.05).At 3 months after treatment,there was significant difference in the proportion of the three groups with mRS ≤2 points (P<0.05).Conclusion  Mechanical thrombectomy and intravenous thrombolysis have a good clinical effect on acute cerebral infarction of aorta,and mechanical thrombectomy is safer than intravenous thrombolysis,and the long-term prognosis is good.
Key words】  Acute cerebral infarction;Stent;Mechanical thrombectomy;Intravenous thrombolysis;Endovascular treatment;Interventional therapy;Prognosis
        脑梗死是导致人类致残和致死的主要疾病之一,具有很高的神经功能障碍和死亡负担[1]。急性缺血性脑梗死约占全部脑卒中的80%[2],动脉溶栓、静脉溶栓及机械取栓等是常用的治疗措施[3],可以尽早把阻塞的血管开通,使缺血半暗带被挽救[4]。本文分析机械取栓、静脉溶栓及保守治疗急性脑梗死的临床效果、安全性及预后。
1  资料与方法
1.1  研究对象  选择2016-06—2018-03安阳市人民医院治疗的急性脑梗死的101例患者为研究对象,根据治疗方法的不同分为A组(机械取栓组,35例)、B组(静脉溶栓组,34例)和C组(保守组,32例)。3组一般资料比较差异无统计学意义(P>0.05)。见表1。本研究经本院伦理委员会批准。
1.2  入选标准  (1)年龄18~80岁;(2)发病时间6 h内;(3)符合急性脑梗死影像学改变,且无早期大面积脑梗死的影像学改变,且符合大动脉闭塞型脑梗死;(4)颅脑CT排除脑内出血;(5)急性缺血性脑卒中导致的神经功能缺损症状且持续超过1 h;(6)美国国立卫生院神经功能缺损量表(NIHSS)评分4~25分;(7)血压控制在180/100 mmHg(1 mmHg=0.133 kPa)以下;(8)签署知情同意书[5-6]
1.3  排除标准  (1)有出血性脑血管病史,近3个月有头颅外伤史,近3周内有消化道或泌尿系统出血,近2周内进行过大的外科手术,近1周内有在不易压迫止血部位的动脉穿刺;(2)6个月内有颅内及椎管内手术史;(3)身体有活动性内出血,急性出血倾向;(4)48h内接受过肝素治疗,APTT超出正常范围的上限;已口服抗凝药者(INR>1.5或PT>15 s);血小板计数<100×109个/L或其他情况;(5)血压>180/100 mmHg,血糖<2.7 mmol/L;(6)有严重脑、心、肝、肾功能不全史;(7)妊娠;(8)不合作者[5-6]
1.4  方法
1.4.1  保守治疗组:内科常规治疗,给予吸氧、心电监护、抗血小板聚集、强化降脂治疗,依据病情调整治疗方案。
1.4.2  静脉溶栓组:给予吸氧、心电监护等内科常规治疗,溶栓24 h后开始使用抗血小板药物。尿激酶溶栓治疗:依照2万U/kg的标准用药,药量不超过150万U,配伍100 mL0.9%氯化钠注射液,30 min内静脉泵入。阿替普酶溶栓治疗:依照0.9 mg/kg的标准用药,用药1 min内使用10%药物静脉推注,剩余90%配伍100 mL0.9%氯化钠注射液1 h内静脉泵入。
1.4.3  机械取栓组:给予动态心电监护生命体征及护理,给予全身麻醉,取右侧腹股沟韧带股动脉处穿刺,置入6F或8F动脉鞘,然后使用0.035”导丝导引将5F猪尾巴导管送至主动脉做主动脉弓造影,后在造影下将5F单弯导管送至病变部位,置入Solitaire支架,配合50 mL注射器负压抽吸,取出血栓,回收支架,复查造影见闭塞血管血流恢复,显示机械取栓成功后,待肝素代谢后拔除动脉鞘,局部压迫止血、加压包扎。术中密切观察患者的生命体征,术后给予抗血小板药物治疗。
1.5  观察指标  使用美国国立卫生研究院卒中量表(NIHSS)评分,比较各组治疗前、治疗后即刻、治疗后 24 h、治疗后1周、治疗后 2周的NIHSS评分,分数越高代表神经功能缺损越严重。比较各组治疗1周后颅内出血率、消化道出血率及1个月后的病死率。使用90 d改良Rankin 量表(mRS)评分[7]比较各组治疗后90d的预后情况,mRS≤2分代表临床预后良好。
1.6  统计学方法  采用SPSS 25.0统计软件进行数据分析,计量资料符合正太分布用均数±标准差(x±s)表示,采用单因素方差分析比较组间差异,计数资料用率(%)率表示,组间计数资料的比较行χ2检验。P<0.05为差异有统计学意义。
表1  3组临床资料比较
Table 1  Comparison of three groups of clinical data
基线资料 A(n=35) B(n=34) C(n=32) F/χ2 P
年龄/ 61.51±13.15 62.29±12.89 65.41±11.36 0.892 0.729
男性[n(%)] 23(65.7) 25(73.5) 17(53.1) 3.035 0.219
收缩压(mmHg) 141.89±19.37 142.38±25.67 145.75±17.96 0.32 0.727
舒张压(mmHg) 83.09±14.76 85.15±12.98 87.84±13.88 0.982 0.378
既往病史          
糖尿病 [n(%)] 5(14.3) 8(23.5) 8(25.0) 1.398 0.479
房颤 [n(%)] 10(45.5) 8(36.4) 4(18.2) 2.626 0.269
高血压 [n(%)] 17(29.3) 17(29.3) 24(41.4) 5.932 0.052
脑卒中 [n(%)] 10(35.7) 7(25.0) 11(39.3) 1.538 0.453
2  结果
        3组治疗前NIHSS评分比较差异无统计学意义 (P>0.05)。治疗后1周、2周,3组NIHSS评分明显低于治疗前,差异有统计学意义 (P<0.05)。与C组比较,A、B组治疗后2周NIHSS评分明显降低,差异有统计学意义(P<0.05);与B组比较,A组治疗后2周NIHSS评分明显降低,差异有统计学意义(P<0.05)。见表2。
        治疗1周后,3组颅内出血及消化道出血发生率比较差异无统计学意义(P>0.05);治疗1个月后,3组病死率比较差异无统计学意义(P>0.05);治疗3个月后,3组mRS评分比较差异有统计学意义(P<0.05)。见表3。A组治疗3个月后mRS≤2分者明显高于B、C组,差异均有统计学意义(分别为χ2=6.52、8.34,P<0.05);B、C组治疗3个月后mRS≤2分者比较差异无统计学意义(χ2=0.16,P>0.05)。见表4。
3  讨论
        急性脑梗死是严重危害人类健康的常见病,为社会和家庭带来沉重的负担。尽早开通被阻塞的血管[8-10],挽救缺血半暗带是提高患者生存率及改善预后的重要措施[11-15]。目前静脉溶栓被认为是最有效的早期血管再通的治疗措施[16-20],但静脉溶栓具有严格的时间窗[21-25]。随着治疗技术的不断提高,以机械取栓为主的血管内治疗可带来明显的获益[26-28],可尽早开通闭塞的血管[29-31]
        机械取栓治疗ACI具有时间窗较长、血管开通率高等优势[20-21,32-35]。2015年,新英格兰医学杂志发表了5项研究结论均为阳性的文章[1,7,22-24],显示缺血性脑卒中血管内治疗优于静脉溶栓治疗。2018年急性缺血性脑卒中血管内治疗中国指南也指出,机械取栓具有血管再通快,出血转化率低及介入时间窗可延长等优点[2]。机械取栓相比于静脉溶栓或标准内科治疗具有更好的神经功能预后[21,25,36-40],推荐为一线治疗方法[10,41-42]
表2  3组治疗前后NIHSS评分比较  (x±s)
Table 2  Comparison of NIHSS scores before and after treatment in 3 groups
时间 A B C F P
入院时 15.93±5.99 14.66±5.98 12.90±4.78 2.099 0.129
治疗后24 h 12.28±4.99 12.28±4.94 13.38±4.72 0.472 0.625
治疗后1 8.69±4.30*# 9.61±5.50* 12.52±4.62 4.072 0.020
治疗后2 5.69±3.91*# 6.81±4.14* 10.86±4.93 11.437 0.000
  注:与C组比较,*P<0.05;与B组比较,#P<0.05
表3  3组治疗后出血、死亡情况及mRS评分比较[n(%)]
Table 3  Comparison of bleeding,death and mRS scores after treatment in 3 groups [n(%)]
项目 A B C χ2 P
颅内出血 6(17.1) 2(5.9) 2(6.3) 3.151 0.207
消化道出血 4(11.4) 5(14.7) 3(9.4) 0.485 0.795
1个月后死亡 5(14.3) 3(8.8) 3(9.4) 0.641 0.726
3个月mRS评分 21(53.8) 10(25.6) 8(20.5) 10.47 0.005
表4  3组临床预后比较
Table 4  Comparison of clinical prognosis of 3 groups
组别 预后良好 预后不良
A 21 14
B 10 24
C 8 24
        静脉溶栓是目前恢复脑血流的最主要的措施之一,药物包括重组织型纤溶酶原激活剂、尿激酶等[2]。静脉溶栓治疗具有简单、快速、费用相对较低、患者易于接受等优点[26]。2008年,欧洲协作组急性脑卒中研究Ⅲ(ECASSⅢ)结果显示,静脉溶栓(3~4.5 h)治疗急性缺血性脑卒中是安全有效的[27-28]。但静脉溶栓出血率较高且血管再通率较低[10],时间窗相对严格[7]等缺点,使其在临床的应用受限。
        本研究显示,机械取栓90 d的良好预后率为57.4%,提示Solitaire支架取栓能提高大动脉卒中的预后[29],但低于SWIFT PRIME试验研究结果(60.2%)与EXTEND-IA试验研究结果(71%),高于ESCAPE试验结果(53.0%)[2],这可能与本研究血管内治疗技术不成熟及样本量较少有关。本研究也发现,急性脑梗死6h内机械取栓具有较高的血管开通率及良好的临床预后。静脉溶栓90 d的良好预后率为44.1%,2组90 d预后率均高于保守治疗组,说明静脉溶栓治疗大动脉急性脑卒中具有一定的临床效果,高于普通内科治疗,但低于机械取栓组[30-31]。无机械取栓血管内治疗条件的医院可选择积极的静脉溶栓治疗,降低致残率及病死率。本研究机械取栓患者的病死率为14.3%,静脉溶栓组为8.8%,保守组为9.4%,这可能与机械取栓患者临床症状较重及并发症较多有关,但3组病死率、颅内出血和消化道出血的发生率差异无统计学意义。因此,机械取栓及静脉溶栓治疗急性脑梗死是安全有效的。
        机械取栓与静脉溶栓均可降低患者治疗后的NIHSS评分,并增加90d良好功能预后,但机械取栓组优于静脉溶栓组。对于大动脉闭塞的脑梗死患者应优先选择机械取栓治疗。本研究存在一定的不足之处,如样本量偏少,存在一定的选择偏倚;观察指标较少,可能存在信息偏倚,尚需要多中心参与、样本量较大的研究进行更深入的探索。
4  参考文献
[1]  GOYAL M,DEMCHUK A M,MENON B K,et al.Randomized assessment of rapid endovascular treatment of ischemic stroke[J].N Eng J Med,2015,372(11):1 019-1 030.
[2]  AMULURU K,ROMERO C E,PYLE L,et al.Mechanical Thrombectomy of Acute Middle Cerebral Artery Occlusion Using Trans-Anterior Communicating Artery Approach[J].World Neurosurg,2018,112:46-52.doi:10.1016/j.wneu.2018.01.038.
[3]  JEON S B,RYOO S M,LEE D H,et al.Multidisci-plinary approah to decrease in-hospital delay for stroke thrombolysis[J].J Stroke,2017,19(2):196-204.
[4]  农媛,肖海.尿激酶静脉溶栓治疗急性脑梗死的影响因素分析[J].中国实用神经疾病杂志,2017,20(20):30-33.  
[5]  GRIESSENAUER CJ,MEDIN C,MAINGARD J,et al.Endovascular Mechanical Thrombectomy in Large-Vessel Occlusion Ischemic StrokePresenting with Low National Institutes of Health Stroke Scale:Systematic Reviewand Meta-Analysis[J].World Neurosurg,2018,110:263-269.doi:10.1016/j.wneu.2017.11.076.
[6]  RANGEL-CASTILLA L,SIDDIQUI AH.Azygous Anterior Cerebral Artery Acute Occlusion Managed With Endovascular Mechanical Thrombectomy:2-Dimensional Operative Video[J].Oper Neurosurg (Hagerstown),2018 Jul 27.doi:10.1093/ons/opy183.
[7]  BERKHEMER O A,FRANSEN P S,BEUMER D,et al.A randomized trial of intraarterial treatment for acute ischemic stroke[J].N Engl J Med,2015,372(1):11-20.
[8]  UNO J,KAMEDA K,OTSUJI R,et al.Mechanical Thrombectomy for Acute Anterior Cerebral Artery Occlusion[J].World Neurosurg,2018,120:e957-e961.doi:10.1016/j.wneu.2018.08.196.
[9]  KHANDELWAL P,YAVAGAL D R,SACCO R L,et al.Acute Ischemic Stroke Intervention[J].J Am Coll Cardiol,2016,67(22):2 631-2 644.
[10]  KHATRI R,VELLIPURAM AR,MAUD A,et al.Current Endovascular Approach to the Management of Acute Ischemic Stroke[J].Curr Cardiol Rep,2018,20(6):46.  
[11]  FROEHLER M T,SAVER J L,Zaidat O O,et al.Interhospital Transfer Before Thrombectomy Is Associ-ated With Delayed Treatment and Worse Outcome in the STRATIS Registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke)[J].Circulation,2017,136(24):2 311-2 321.
[12]  COUTINHO J M,LIEBESKIND D S,Slater L A,et al.Combined Intravenous Thrombolysis and Thrombectomy vs Thrombectomy Alone for Acute Ischemic Stroke:A Pooled Analysis of the SWIFT and STAR Studies[J].JAMA Neurol.2017,74(3):268-274.
[13]  GOYAL M,MENON B K,VAN ZWAM W H,et al.Endovascular thrombectomy after large-vessel ischaemic stroke[J].Lancet,2016,387(10 029):1 723-1 731.
[14]  李华,梁维,余振威.急性缺血性脑卒中静脉溶栓预后的影响因素分析[J].中国实用神经疾病杂志,2018,21(1):34-36.
[15]  BOULOUIS G,LAUER A,SIDDIQUI AK,et al.Clinical Imaging Factors Associated WithInfarct Progression in Patients With Ischemic Stroke During Transfer forMechanical Thrombectomy[J].JAMA Neurol,2017,74(11):1 361-1 367.doi:10.1001/jamaneurol.2017.2149.
[16]  CHOI J H,IM S H,LEE K J,et al.Comparison of Outcomes After Mechanical Thrombectomy Alone or Combined with Intravenous Thrombolysis and Mechanical Thrombectomy for Patients with Acute Ischemic Stroke due to Large Vessel Occlusion[J].World Neurosurg,2018,114:e165-e172.
[17]  ZAIDAT OO,CASTONGUAY AC,NOGUEIRA RG,et al.TREVO stent-retriever mechanical throm-bectomy for acuteischemic stroke secondary to large vessel occlusion registry[J].J Neurointerv Surg,2018,10(6):516-524.doi:10.1136/neurintsurg-2017-013328.  
[18]  FROEHLER MT,SAVER JL,ZAIDAT OO,et al.Interhospital Transfer Before Thrombectomy Is Associated With Delayed Treatmentand Worse Outcome in the STRATIS Registry (Systematic Evaluation of PatientsTreated With Neurothrombectomy Devices for Acute Ischemic Stroke)[J].Circulation,2017,136(24):2 311-2 321.doi:10.1161/CIRCULATIONAHA.117.028920.
[19]  GERSCHENFELD G,MURESAN I P,BLANC R,et al.Two Paradigms for Endovascular Thrombectomy After Intravenous Thrombolysis for Acute Ischemic Stroke[J].JAMA Neurol,2017,74(5):549-556.
[20]  ACHIT H,SOUDANT M,HOSSEINI K,et al.Cost-Effectiveness of Thrombectomy in Patients With AcuteIschemic Stroke:The THRACE Randomized Controlled Trial[J].Stroke,2017,48(10):2 843-2 847.doi:10.1161/STROKEAHA.117.017856.
[21]  DARGAZANLI C,CONSOLI A,GORY B,et al.Is Reperfusion Useful in Ischaemic StrokePatients Presenting with a Low National Institutes of Health Stroke Scale and a Proximal Large Vessel Occlusion of the Anterior Circulation?[J].Cerebrovase Dis,2017,43(5/6):305-312.
[22]  CAMPBELL B C,MITCHELL P J,KLEING T J,et al.Endovascular therapy for ischemic stroke eith perfusion-imaging selection[J].N Engl J Med,2015,372(11):1 009-1 018.
[23]  JOVIN T G,CHAMORRO A,COBO E,et al.Thrombectomy within 8 hours after symptom onset in ischemic stroke[J].N Engl J Med,2015,372(24):2 296-2 306.
[24]  SAVER J L,GOYAL M,BONAFE A,et al.Stent-retriever thrombectomy after intravenous t-PA vs t-PA alone in stroke[J].N Engl J Med,2015,372(24):2 285-2 295.
[25]  VAN DEN BERG L A,DIJKGRAAF M G,BERKHE-MER O A,et al.Tow-year Outcome after Endovascular Treatment for Acute Ischemic Stroke[J].N Eng J Med,2017,376(14):1 341-1 349.
[26]  ATCHANEEYASAKUL K,LESLIE-MAZWI T,DONAHUE K,et al.White MatterHyperintensity Volume and Outcome of Mechanical Thrombectomy With Stentriever inAcute IschemicStroke[J].Stroke,2017,48(10):2 892-2 894.doi:10.1161/STROKEAHA.117.018653.
[27]  HACKE W,KASTE M,BLUHMKI E,et al.Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stoke[J].N Engl J Med,2008,359:1 317-1 329.
[28]  LEES K R,EMBERSON J,BLACKWELL L,et al.Effects of Alteplase for Acute Stroke on the Distribution of Functional Outcomes:A pooled Analysis of 9 Trials[J].Stroke,2016,47(9):2 373-2 379.
[29]  WONG J W P,CHURILOV L,DOWLING R,et al.Safety of Endovascular Thrombectomy for Acute Ischaemic Stroke in Anticoagulated Patients Ineligible forIntravenousThrombolysis[J].Cerebrovasc Dis,2018 46(5/6):193-199.
[30]  NOGUEIRA R G,FREI D,KIRMANI J F,et al.Safety and Efficacy of a 3-Dimensional Stent Retriever With Aspiration-Based Thrombectomy vs Aspiration-Based Thrombectomy Alone in Acute Ischemic Stroke Intervention:A Randomized Clinical Trial[J].JAMA Neurol,2018 75(3):304-311.
[31]  LIU Z S,DENG G,ZHOU L J,et al.Comparison of Micro-Clamping Stent-Retriever Thrombectomy with Conventional Stent-Retriever Thrombectomy in Intracranial Large Vessel Embolism[J].World Neurosu-rg,2018,116:e662-e669.
[32]  FISCHER U,KAESMACHER J,MENDES PEREIRA V,et al.Direct Mechanical Thrombectomy VersusCombined Intravenous and Mechanical Thrombectomy in Large-Artery Anterior Circulation Stroke:A Topical Review[J].Stroke,2017,48(10):2 912-2 918.doi:10.1161/STROKEAHA.117.017208.
[33]  LAPERGUE B,BLANC R,GORY B,et al.Effect of Endovascular Contact Aspiration vs Stent Retriever onRevascularization in Patients With Acute Ischemic Stroke and Large VesselOcclusion:The ASTER Randomized Clinical Trial[J].JAMA,2017,318(5):443-452.doi:10.1001/jama.2017.9644.
[34]  WANG H,THEVATHASAN A,DOWLING R,et al.StreamliningWorkflow for Endovascular Mechanical Thrombectomy:Lessons Learned from aComprehensive Stroke Center[J].J Stroke Cerebrovasc Dis,2017,26(8):1 655-1 662.doi:10.1016/j.jstrokecerebrovasdis.2017.04.021.
[35]  VIDALE S,AGOSTONI E.Endovascular Treatment of Ischemic Stroke:An Updated Meta-Analysis of Efficacy and Safety[J].Vasc Endovascular Surg,2017,51(4):215-219.doi:10.1177/1538574417698905.
[36]  TAWIL SE,MUIR KW.Thrombolysis and thrombectomy for acute ischaemic stroke[J].Clin Med (Lond),2017,17(2):161-165.doi:10.7861/clinmedicine.17-2-161.
[37]  DEREX L,CHO TH.Mechanical thrombectomy in acute ischemic stroke[J].Rev Neurol,2017,173(3):106-113.doi:10.1016/j.neurol.2016.06.008.
[38]  COUTINHO J M,LIEBESKIND D S,SLATER L A,et al.CombinedIntravenous Thrombolysis and Thrombectomy vs Thrombectomy Alone for AcuteIschemic Stroke:A Pooled Analysis of the SWIFT and STAR Studies[J].JAMA Neurol,2017,74(3):268-274.doi:10.1001/jamaneurol.2016.5374.
[39]  ATWAL G S,SIDDIQUI A H.Mechanical Thrombectomy for Acute Ischemic Stroke:AreWe Done?[J].JAMA Neurol.2017.74(3):259.doi:10.1001/jamaneurol.2016.5322.
[40]  BEKELIS K,MISSIOS S,MACKENZIE TA,et al.AnesthesiaTechnique and Outcomes of Mechanical Thrombectomy in Patients With Acute IschemicStroke[J].Stroke,2017,48(2):361-366.doi:10.1161/STROKEAHA.116.015343.
[41]  CARVALHO A,CUNHA A,RODRIGUES M,et al.Mechanical Thrombectomy in Acute IschemicStroke:Initial Single-Center Experience and Comparison with Randomized Controlled Trials[J].J Stroke Cerebrovasc Dis,2017,26(3):589-594.doi:10.1016/j.jstrokecerebrovasdis.2016.11.116.
[42]  SATTI S,CHEN J,SIVAPATHAM T,et al.Mechani-cal thrombectomyfor pediatric acute ischemic stroke:review of the literature[J].J NeurointervSurg,2017,9(8):732-737.doi:10.1136/neurintsurg-2016-012320.
(收稿2018-09-05  修回2018-10-05)
本文责编:夏保军
本文引用信息:李琳琳,杨清成,张建刚,郭艳平,李佳佳,王禹.机械取栓与静脉溶栓治疗急性脑梗死临床分析[J].中国实用神经疾病杂志,2018,21(21):2350-2355.DOI:10.12083/SYSJ.2018.21.504
Reference information:LI Linlin,YANG Qingcheng,ZHANG Jiangang,GUO Yanping,LI Jiajia,WANG Yu.Clinical analysis of mechanical thrombectomy and intravenous thrombolysis for acute cerebral infarction[J].Chinese Journal of Practical Nervous Diseases,2018,21(21):2350-2355.DOI:10.12083/SYSJ.2018.21.504
所属栏目:论著
分享本页至: