80岁及以上老年急性缺血性卒中患者支架机械取栓的疗效

The therapeutic effects of stent retriever-based thrombectomy on acute ischemia stroke in patients aged 80 years and over

目的评价可回收支架机械取栓（stent retriever—based thrombectomy，SRT）技术在大血管闭塞的80岁及以上老年急性缺血性卒中（acute ischemia stroke，AIS）患者中的安全性及治疗效果。方法选择2016年1月至2017年5月在首都医科大学附属北京天坛医院实施血管内SRT的157例患者，按照年龄分为〈80岁及≥80岁两组，比较两组的基线信息包括性别构成、发病前改良Rankin量表（mRS）评分、既往病史、吸烟史、术前阿尔伯塔卒中项目早期CT评分（ASPECTS）、术前神经功能缺损程度卒中量表（NIHSS）评分及是否静脉溶栓；比较两组手术相关信息包括发病至入院时间、到院至穿刺时间、穿刺至血管开通时间以及sRT并发症（症状性颅内出血、死亡）和90dmRS；采用Logistic回归分析判定年龄是否为SRT术后预后的影响因素。结果〈80岁组共130例患者、≥80岁组有27例患者，两组患者基线信息的差异均无统计学意义（均P〉0．05）；两组患者手术相关信息、SRT并发症以及临床结局的差异也均无统计学意义（均P〉0．05）。采用Logistic回归分析，以不同临床结局为因变量，调整性别、入院ASPECTS评分、NIHSS评分和溶栓后，结果显示，是否高龄（≥80岁）并不是影响临床结局的因素（OR=0．738，95％CI：0．300～1．813）。结论≥80岁的大血管闭塞急性缺血性卒中患者实施SRT同样安全并获益。

Objective To evaluate the safety and therapeutic effects of stent retriever-based thrombectomy （SRT） on acute ischemic stroke （AIS） in patients aged 80 years and older. Methods A cohort of 157 AIS patients hospitalized in Capital Medical University Affiliated Beijing Tiantan Hospital were selected for SRT from January 2016 to May 2017. Based on the age, all patients were divided into two groups： groups aged 〈 80 years and ≥ 80 years. Baseline information including gender,the Modified Rankin Scale （mRS） score, past medical history, smoking history, preoperative National Institutes of Health Stroke Scale （NIHSS）, the Alberta Stroke Program Early CT Scores （ASPECTS） ,intravenous thrombolysis and clinical outcomes were compared between two groups. The informations related to the operation,including time from onset to hospital,door- to -needle puncture time,door- to -recanalization time, SRT complications （symptomatic cerebral hemorrhage, mortality） and good outcome, were compared between two groups. Logistic regression analysis was used to determine whether the age of 80 years and over was a risk factor for adverse prognosis after SRT. Results There were 130 patients in the group ≥ 80 years of age,and 27 patients in the group ≥80 years. No significant differences were found in baseline information between the two groups （all P〉 0.05 ）. In addition, there were no significant differences in the proportions of the operative information, complications of SRT and the good outcome （all P0.05）. Furthermore, advanced age （≥80 years） was not a risk factor for adverse outcome after SRT （OR = 0. 738, 95% CI= 0. 300 - 1. 813）. Conclusions Stent retriever-based thrombectomy is safe and beneficial for patients with acute ischemic stroke,even in patients aged 80 years and over.