大动脉粥样硬化与心源性栓塞大脑中动脉M1段闭塞急性缺血性脑卒中血管内治疗单中心回顾性分析

目的 探讨大动脉粥样硬化（LAA）与心源性栓塞（CE）大脑中动脉M1段闭塞急性缺血性脑卒中（AIS）患者的临床特点及血管内治疗差异。方法 连续回顾性纳入2014年9月至2018年2月在我院行血管内治疗的LAA与CE大脑中动脉M1段闭塞AIS患者，比较分析两组在临床特点、血管内治疗方式、术后颅内出血发生率及预后等方面的差异。结果 共纳入患者134例，其中LAA患者48例，男39例、女9例，年龄为42～82（62.65±9.76）岁；CE患者86例，男40例、女46例，年龄为34～87（69.66±12.43）岁；两组性别、平均年龄差异均有统计学意义（χ2=15.363、t=－3.371，P均<0.05）。LAA患者高血压病占比高于CE患者[70.8%（34/48）vs 51.2%（44/86），χ2=4.900，P=0.027]，入院时美国国立卫生研究院卒中量表评分低于CE患者[13（7，16）分vs 16（13，21）分，Z=－3.603，P<0.001]。采用血管成形术的LAA患者比例为52.1%（25/48），高于CE患者的4.7%（4/86；χ2=38.121，P<0.01）。LAA患者术后颅内出血发生率低于CE患者[10.4%（5/48）vs 32.6%（28/86），χ2=8.136，P=0.004]。两组在术后症状性颅内出血发生率、血管成功再通率以及术后3个月良好预后率和死亡率方面差异均无统计学意义（P均>0.05）。结论 大脑中动脉M1段闭塞的AIS患者中，CE患者发病时症状较重，且血管内治疗后颅内出血发生率较高。LAA和CE患者的血管内治疗方式不同，但预后和死亡率无明显差异。
Objective To investigate the clinical characteristics of the patients with acute ischemic stroke (AIS) caused by large artery atherosclerosis (LAA) or cardioembolism (CE) middle cerebral artery M1 segment occlusion, and to explore the difference of endovascular treatment. Methods The patients with AIS caused by M1 segment occlusion, who received endovascular treatment between Sep. 2014 and Feb. 2018 in our hospital, were recruited and assigned to LAA group and CE group. Clinical characteristics, treatment strategy, postoperative hemorrhage rate and prognosis were analyzed. Results Totally 134 patients were included, and 48 patients were in the LAA group and 86 patients were in the CE group. There were significant differences in the gender and age between the LAA and CE groups (male/female 39/9 vs 40/46, χ2=15.363; average age[62.65±9.76] years vs[69.66±12.43] years, t=-3.371; both P<0.05). Compared with the CE group, the proportion of the patients with hypertension was significantly higher, and the National Institutes of Health stroke scale score on admission was significantly lower in the LAA group (70.8%[34/48] vs 51.2%[44/86], χ2=4.900, P=0.027; 13[7, 16] vs 16[13, 21], Z=-3.603, P<0.001). The proportion of the patients with angioplasty in the LAA group was 52.1% (25/48), which was significantly higher than the proportion in the CE group (4.7%[4/86], χ2=38.121, P<0.01). The incidence of postoperative intracranial hemorrhage was significantly lower in the LAA group than that in the CE gorup (10.4%[5/48] vs 32.6%[28/86], χ2=8.136, P=0.004). There were no significant differences in the incidence of symptomatic intracranial hemorrhage, endovascular recanalization rate, or good prognosis rate or mortality 3 months after operation between the two groups (all P>0.05). Conclusion Compared with the patients with AIS due to LAA M1