| Objective: This study mainly analysis the efficiency and safety of mechanical thrombectomy with Solitaire stent through comparing the curative effect and the prognosis of acute anterior circulation cerebral infarction by mechanical thrombectomy using Solitaire stent with by artery catheterization thrombolysis. And how to apply Solitaire stent in ultra early mechanical thrombectomy for the treatment of acute cerebral infarction, reduce the complications, improve the curative effect and the prognosis of acute cerebral infarction clinical, which was summarized.Methods: We collected 71 cases of patients who were confirmed the diagnosis of acute anterior circulation arterial occlusion totally from December 2013 to December 2015 in the Department of Neurosurgery, the first hospital of Hebei Medical University. According to the treatment,a total of 41 patients were given mechanical thrombectomy using Solitaire stent, and a total of 30 patients were given artery catheterization thrombolysis. We observe the vascular recanalization of the patients after surgical intervention, which was evaluated by Thrombolysis in Cerebral Ischemia Scale(TICI). We monitor and compare the test data of postoperative blood coagulation function and v WF 1 day after surgery. The incidence of surgical complications was analyzed and compared, including symptomatic intracerebral hemorrhage cerebral vasospasm, secondary cerebral embolism and others. The two groups were assessed by neurologists using National Institutes of Health Stroke Scale(NIHSS score) at admittance to the hospital and after surgical intervention, to evaluate their nerve function recovery after acute ischemic stroke. We defined clinical improvement as a 6-point decline in the NIHSS score from baseline to discharge.The clinical prognosis after discharge are compared by Modified Rankin Scale and analyzed statistically.Results:1 The two groups underwent postoperative cerebral angiography to evaluate the recovery of bloodstream after surgical intervention. Of the group treated with mechanical thrombectom, 21 cases got grade 3(TICI), 6 cases got grade 2a(TICI), 8 cases got grade 2b(TICI), 4 cases got grade 1(TICI), and 2 cases got grade(TICI). Our research considered recanalization when TICI Scale?grade 2, there were 35 cases that got recanalization, and recanalization rate was 85.36% in the group treated with mechanical thrombectom. And of the group treated with arterial thrombolysis, 5 cases got grade 3(TICI), 5 cases got grade 2a(TICI), 9 cases got grade 2b(TICI), 9 cases got grade(TICI), and 2 cases got grade 0(TICI).19 cases achieved recanalization and recanalization rate was 63.33%.The recanalization rates of The two groups were compoared by chi square test analysis(x~2=6.618, P=0.032),and the difference was statistically significant(P<0.05). Recanalization rate of the group with Mechanical thrombectomy was higher.2 The morbidity and the incidence of significant complications was compared between thrombectomy thrombolysis and arterial thrombolysis. We researchedthe significant complicationson including symptomatic intracerebral hemorrhage cerebral vasospasm, secondary cerebral embolism and others. Of the group treated with mechanical thrombectom, 2 cases suffered from symptomatic intracerebral hemorrhage, 3 cases suffered from cerebral vasospasm, 2 cases suffered from secondary thrombosis and 3 cases were dead. And of the group treated with arterial thrombolysis, 1 cases suffered from symptomatic intracerebral hemorrhage, 2 cases suffered from cerebral vasospasm, 2 cases suffered from secondary thrombosis and 2 cases were dead. The complication rates between the two groups of patients(17.1% vs 16.7%, x~2=0.002, P=0.964), had no significant difference. And the mortality between the two groups of patients(7.3% vs 6.7%, continuous correction x~2=0.000, P=0.916) had no significant difference, either.3 We compared baseline and discharge NIHSS score in each groups, which were analyzed by two-related rank sum test; the group treated with mechanical thrombectom(Z=-4.148, P<0.05)and the group treated with arterial thrombolysis(Z=-3.745,P<0.05)were both statistically significant.The two groups both had lower discharged NIHSS score than baseline NIHSS. But the discharged NIHSS score of the two groups were analyzed by independent sample rank sum test(9 vs 11, Z=1.433, P>0.05). The difference between the two groups was not statistically significant. F or research purposes, we will compared discharge NIHSS score with the baseline NIHSS score, when decreased more than 6 points, as for the improvement of nerve function. And when score of coronary collateral circulation(ASITN/SIR flow grade) higher than or equal to grade 2 which was considered as good collateral circulation. In the patients with good collateral circulation conditions, the improvement of the nerve function between the two groups was different(P<0.05), and the difference had statistical significance; but in patients with poor collateral circulation conditions, and improvement of the nerve function between the two groups had difference which had no statistical significance(P>0.05).4 Test dataThe test data of v WF(2.40±0.326 vs 2.38±0.333)IU/ml,which was compared between the two groups of patients. But the difference does not have statistical significance(t=0.154,P=0.69>0.05).5 Follow-up dataWhen the two groups of patients were discharged from hospital, we used telephone to follow up with the patient's prognosis which was evaluated by the 90-day modified Rankin score, and we considered less than or equal to 2 level as improved prognosis,(43.9% vs 36.7%, x~2=0.002, P=0.54) comparisons between the two groups of patients. But the difference does not have statistical significance.Conclusions:1 The results of this research showed that compared with Intra-arterial Thrombolysis, mechanical thrombectomy with Solitaire stent can provide higher recanalization rate and better outcome for Acute anterior circulation vascular occlusion and the treatment is effective,especially for the good collateral circulation.2 Compared with intra-arterial thrombolysis, the incidence of surgical complications after mechanical thrombectomy with solitaire stent, including symptomatic intracerebral hemorrhage cerebral vasospasm, secondary cerebral embolism and others,which was not increased;the treatment of mechanical thrombectomy in the treatment of acute anterior circulation cerebral infarction was proven to be safe. |
PDF Full Text Request