前循环急性大血管闭塞性脑卒中桥接治疗与直接血管内治疗的疗效比较

Efficacy of bridging therapy versus direct endovascular treatment in patients with acute ischemic stroke due to large vessel occlusion in the anterior circulation

摘要:

目的 探讨县区级医院前循环急性大血管闭塞性脑卒中（AIS-LVO）患者接受静脉溶栓桥接血管内治疗与直接血管内治疗的临床疗效差异及预后的影响因素。方法 回顾性纳入2021年3月至2024年9月珠海市第五人民医院收治的54例AIS-LVO患者作为研究对象。根据治疗方式分为桥接组（39例，进行阿替普酶/尿激酶溶栓后桥接取栓）和介入组（15例，因禁忌证直接进行血管内取栓）。主要结局为术后90 d改良Rankin量表（mRS）评分（有效：mRS评分0～4分；无效：mRS评分5～6分），次要结局包括血管再通率（mTICI分级≥2b）、症状性颅内出血（sICH）及术后（7±2） d的美国国立卫生研究院卒中量表（NIHSS）改善值。采用Firth校正Logistic回归分析评估预后独立预测因素。结果 桥接组90 d功能独立率（mRS评分0～4分）高于介入组（79.5% vs. 46.7%，P=0.043）。桥接治疗可降低90 d不良预后的风险（OR=0.22，P=0.032）。两组血管再通率（82.1% vs. 66.7%）和sICH发生率（7.7% vs. 13.3%）比较，差异无统计学意义（P>0.05）。术后90 d的mRS评分与术前NIHSS评分（ρ=0.46）、术后（7±2） d的NIHSS评分（ρ=0.81）和年龄（ρ=0.30）呈正相关（均P<0.05）。术后90 d的mRS评分与NIHSS评分改善值（ΔNIHSS）呈负相关（ρ=-0.58，P<0.001）。结论 在县区级医院条件下，桥接治疗较直接血管内治疗显著改善前循环AIS-LVO患者90 d的功能预后，且安全性相当。

Abstract:

Objective To investigate the clinical efficacy of bridging therapy versus direct endovascular treatment in intravenous thrombolysis for patients with acute ischemic stroke due to large vessel occlusion （AIS-LVO） in the anterior circulation in county- and district-level hospitals and the influencing factors for prognosis.Methods A retrospective analysis was performed for 54 patients with AIS-LVO who were admitted to The Fifth People's Hospital of Zhuhai from March 2021 to September 2024， and according to the treatment modality， they were divided into bridging group （39 patients undergoing bridging thrombectomy after alteplase/urokinase thrombolysis） and intervention group （15 patients undergoing direct endovascular thrombectomy due to contraindications）. The primary outcome was modified Rankin Scale （mRS） score on day 90 after surgery （favorable： an mRS score of 0-4； unfavorable： an mRS score of 5-6）， and secondary outcomes included revascularization rate （mTICI≥2b）， symptomatic intracranial hemorrhage （sICH）， and improvement in National Institutes of Health Stroke Scale （NIHSS） score on day （7±2） after surgery. A Firth's penalized-likelihood logistic regression analysis was used to investigate the independent predictive factors for prognosis.Results The bridging group had a significantly higher 90-day functional independence rate （an mRS score of 0-4） than the intervention group （79.5% vs 46.7%， P=0.043）. Bridging therapy is associated with a reduced risk of 90-day adverse outcomes （odds ratio=0.22， P=0.032）. There were no significant differences between the two groups in recanalization rate （82.1% vs 66.7%， P>0.05） and the incidence rate of sICH （7.7% vs 13.3%， P>0.05）. The 90-day mRS score on day 90 after surgery was positively correlated with baseline NIHSS score （ρ=0.46， P<0.05）， NIHSS score on day （7±2） after surgery （ρ=0.81， P<0.05）， and age （ρ=0.30， P<0.05）， while it was negatively correlated with the improvement in NIHSS score （ρ=-0.58， P<0.001）.Conclusions In county- and district-level hospitals， compared with direct endovascular treatment， bridging therapy significantly improves 90-day functional outcomes in patients with AIS-LVO， with a comparable safety profile.