A comparative study of mechanical thrombectomy and intravenous thrombolysis in acute vertebrobasilar occlusive cerebral infarction
10.3760/cma.j.cn115354-20200315-00190
- VernacularTitle:机械取栓和静脉溶栓治疗急性椎基底动脉闭塞性脑梗死的效果比较
- Author:
Yangjun PAN
1
;
Jianguo YANG
;
Yinyuan ZHENG
;
Weijie LU
;
Ru SUN
;
Xingzhen FEI
;
Zheng XU
Author Information
1. 湖州市第一人民医院（湖州师范学院附属第一医院）卒中中心 313000
- Keywords:
Acute vertebrobasilar artery occlusion;
Mechanical thrombectomy;
Intravenous thrombolysis;
Bridging treatment
- From:
Chinese Journal of Neuromedicine
2020;19(7):677-682
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the therapeutic efficacies of mechanical thrombectomy (MT) and intravenous thrombolysis (IT) in patients with acute vertebrobasilar occlusive cerebral infarction.Methods:A prospective inclusion of 111 patients with acute vertebrobasilar artery occlusion admitted to our hospital from February 2014 to December 2019 was performed; these patients were divided into MT group ( n=66) and IT group ( n=45) according to the wishes of their families. MT was performed directly in patients from the MT group; IT was performed firstly in those from the IT group, and MT (also known as bridging treatment) was then used for those who showed no efficacy in IT when condition permission and having family member's willing. Vascular recanalization rate, incidence of symptomatic intracranial hemorrhage, National Institutes of Health Stroke Scale (NIHSS) scores, modified Rankin Scale (mRS) scores and mortality rate were assessed in the two groups after treatment. Results:During the course of the study, 7 patients (4 in the MT group and 3 in the IT group) dropped out, and finally 104 (62 in the MT group and 42 in the IT group) were included in the statistical analysis. Fifty-four patients in MT group had succeeded recanalization, and the recanalization rate (87.1%) was statistically higher than that in IT group (61.9%, P<0.05). There were 8 patients (12.9%) with symptomatic intracranial hemorrhage in MT group and 6 patients (14.3%) in IT group, without significant difference ( P>0.05). The treatment effective rate (difference value of NIHSS scores before and after treatment≥4 or NIHSS score after treatment=0) in patients from MT group (67.7%) was significantly higher than that in IT group (38.1%), the good prognosis rate (58.1%) was statistically higher than that in IT group (28.6%), and the mortality rate (3.2%) was statistically lower than that in IT group (14.3%, P<0.05). Among the 16 patients who did not receive IT, 14 patients changed to accept bridging treatment (2 family members refused re-thrombectomy); the vascular recanalization rate (78.6%), intracranial hemorrhage rate (14.3%), treatment effective rate (50.0%), good prognosis rate (57.1%), and mortality rate (7.1%) showed no significant differences as compared with those in the MT group ( P>0.05). Conclusion:For patients with acute vertebrobasilar occlusive cerebral infarction, MT can improve the vascular recanalization rate and clinical prognosis; even after the failure of IT, re-thrombectomy (bridging treatment) is still safe and effective.
