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| 血管内治疗后循环大血管闭塞急性缺血性脑卒中的临床疗效 |
| 王蒙恩1,2,孙洪扬2,陈旺2,王浩2,朱其义2,韩红星2*,王贤军2* |
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(1. 潍坊医学院临床医学院, 潍坊 261053;
2. 临沂市人民医院神经内科, 临沂 276000
*通信作者) |
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| 摘要: |
| 目的 评估血管内治疗后循环大血管闭塞急性缺血性脑卒中（AIS-LVO）的疗效和安全性。方法 回顾性分析2019年12月至2020年12月于临沂市人民医院行血管内治疗的82例后循环AIS-LVO患者资料。采用改良脑梗死溶栓（mTICI）分级评价血管再通情况，其中mTICI分级≥2b级为血管成功再通；采用改良Rankin量表（mRS）评价术后90 d预后情况，其中mRS评分≤2分为预后良好，3~6分为预后不良；同时记录患者术后症状性颅内出血（sICH）的发生率及术后90 d死亡率。采用多因素logistic回归分析确定血管内治疗后90 d预后的独立影响因素。结果 71例入组AIS-LVO患者中，61例（85.9%）术后即刻mTICI分级≥2b级，其中mTICI 2b级23例、mTICI 3级38例。6例（8.5%）发生sICH。术后90 d时随访，30例（42.3%）患者预后良好、41例（57.7%）预后不良，20例（28.2%）死亡。与预后不良组相比，预后良好组有饮酒史患者的占比较低，术前美国国立卫生研究院卒中量表（NIHSS）评分较低，术前意识清醒患者的占比较高，后交通动脉开放患者的占比较高，股动脉穿刺至血管再通时间较短，差异均有统计学意义（P均< 0.05）。多因素logistic回归分析显示，术前NIHSS评分（OR=1.116，95%CI 1.010~1.232，P=0.030）、股动脉穿刺至血管再通时间（OR=1.019，95%CI 1.005~1.034，P=0.008）、后交通动脉开放（OR=0.285，95%CI 0.103~0.787，P=0.015）是后循环AIS-LVO患者血管内治疗后90 d预后的独立影响因素。结论 血管内治疗后循环AIS-LVO患者可能是安全、有效的，能够改善部分患者的临床结局。 |
| 关键词: 急性缺血性脑卒中 后循环 大血管闭塞 血管内治疗 预后 |
| DOI：10.16781/j.0258-879x.2022.01.0087 |
| 投稿时间：2021-09-17 |
| 基金项目:山东省医药科技卫生发展计划项目（2019WS128） |
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| Clinical efficacy of endovascular treatment for acute ischemic stroke with large vessel occlusion in posterior circulation |
| WANG Meng-en1,2,SUN Hong-yang2,CHEN Wang2,WANG Hao2,ZHU Qi-yi2,HAN Hong-xing2*,WANG Xian-jun2* |
(1. Clinical Medical College, Weifang Medical University, Weifang 261053, Shandong, China;
2. Department of Neurology, Linyi People's Hospital, Linyi 276000, Shandong, China
*Corresponding authors) |
| Abstract: |
| Objective To evaluate the efficacy and safety of endovascular treatment for acute ischemic stroke with large vessel occlusion (AIS-LVO) in the posterior circulation.Methods The data of 82 patients with posterior circulation AIS-LVO who received endovascular treatment in Linyi People's Hospital from Dec. 2019 to Dec. 2020 were retrospectively analyzed. Vascular recanalization was evaluated by modified thrombolysis in cerebral infarction (mTICI) grade, and the mTICI grade ≥ 2b indicated successful vascular recanalization. Modified Rankin scale (mRS) was used to evaluate the prognosis 90 d after operation, and the mRS score ≤ 2 indicated good prognosis and 3-6 indicated poor prognosis. The incidence of symptomatic intracranial hemorrhage (sICH) after operation and mortality 90 d after operation were recorded. Multivariate logistic regression analysis was used to determine the independent influencing factors of the prognosis 90 d after endovascular treatment.Results Totally 71 AIS patients were included, and 61 (85.9%) of them had immediate postoperative mTICI grade ≥ 2b, including 23 grade 2b and 38 grade 3. sICH occurred in 6 (8.5%) patients after operation. Thirty (42.3%) patients had a good prognosis, 41 (57.7%) had a poor prognosis, and 20 (28.2%) died 90 d after operation. Compared with the poor prognosis group, the proportion of patients with drinking and preoperative National Institutes of Health stroke scale (NIHSS) score were significantly lower, the proportion of patients with consciousness before operation and proportion of patients with posterior communicating artery opening were significantly higher, and puncture-to-recanalization time was significantly shorter in the good prognosis group (all P < 0.05). Multivariate logistic regression analysis showed that preoperative NIHSS score (odds ratio[OR]=1.116, 95% confidence interval[CI] 1.010-1.232, P=0.030), puncture-to-recanalization time (OR=1.019, 95% CI 1.005-1.034, P=0.008) and posterior communicating artery opening (OR=0.285, 95% CI 0.103-0.787, P=0.015) were independent influencing factors for prognosis of patients with posterior circulation AIS-LVO 90 d after endovascular treatment.Conclusion Endovascular treatment is safe and effective in patients with posterior circulation AIS-LVO, and it can improve the clinical outcome of some patients. |
| Key words: acute ischemic stroke posterior circulation large vessel occlusion endovascular treatment prognosis |
