高龄急性缺血性卒中患者机械再通治疗不良预后的原因分析

A root-cause analysis of poor prognosis in patients aged 80 years and over with acute ischemic stroke after mechanical thrombectomy

目的探讨高龄患者机械再通治疗的安全性、有效性并分析不良预后原因。方法回顾我院2017年1月至2018年6月收治的急性缺血性卒中行机械再通治疗且年龄≥80岁的患者,收集基线信息、影像学、再通治疗与并发症、临床预后等资料,分析不良预后的具体原因。结果共纳入20例高龄患者,年龄80~96岁,平均(83.3±4.1)岁。均行血管内机械再通治疗,再通成功(mTICI 2b-3)率为70%;技术性并发症发生率为15%,其中,症状性脑出血发生率为5%。3个月随访预后良好(mRS 0~2级)者35%,预后不良者(mRS 4~6级)55%。分析该11例患者预后不良的原因,归因于发病重或就诊时间较晚者2例;归于再通不成功或再通并发症者3例;归于高龄相关因素者6例,其中,合并闭塞以外动脉多发重度狭窄、侧支血流代偿差、卒中进展迅速者3例,因内科并发症加重致预后不良者3例。结论高龄卒中患者存在内科并发症较多、伴有闭塞血管以外其他动脉重度狭窄等;侧支代偿差、原有内科并发症等可能是再通治疗不良预后的重要原因。

Objective To explore the safety and effectiveness of mechanical thrombectomy in patients ≥80 years old, and to analyze the causes of poor prognosis. Methods The data of twenty consecutive patients ≥80 years old with acute ischemic stroke who underwent mechanical thrombectomy in our hospital from January 2017 to June 2018 were retrospectively reviewed.Baseline information, imaging data, thrombectomy procedures, complications, and clinical prognosis were collected.The causes of poor prognosis were analyzed. Results A total of 20 advanced age patients were included, with an average age of (83.3±4.1)years(range 80 to 96 years). All patients underwent mechanical thrombectomy, and the successful recanalization rate(mTICI 2b-3)was 70%.The incidence of technical complications was 15%, of which the rate of symptomatic intracranial hemorrhage was 5%.Among the 11 patients with poor prognosis, the causes included the severe diseases and later revascularization in 2 patients, unsuccessful recanalization or complications in 3 cases, and advanced age-related factors in 6 cases, among which there were accompanied multiple severe stenoses, poor collaterals and the rapid progress of stroke in 3 cases and the aggravation of previous comorbidities in 3 cases. Conclusions The advanced age patients ≥80 years old often have more comorbidities, higher prevalence rates of multiple severe vascular stenosis except the occluded vessels, poor collateral compensation and the aggravation of original comorbidities.And all of them may be important factors for the poor prognosis after mechanical thrombectomy.