SolitaireAB支架取栓治疗心房颤动患者急性脑梗死疗效及转归不良因素分析

Effect of SolitaireAB stent thrombectomy on AF-induced acute cerebral infarction and risk factors for its poor outcome

目的评价SolitaireAB支架取栓治疗心房颤动(房颤)脑梗死疗效及转归不良的影响因素.方法选择超早期脑梗死患者78例,根据病因分为房颤取栓组(A组)47例和大动脉粥样硬化取栓组(B组)31例.2组均行SolitaireAB支架取栓治疗,用美国国立卫生研究院卒中量表(NIHSS)评分评定神经功能,用改良Rankin量表评价预后.比较2组取栓治疗的有效性、安全性;绘制生存曲线,评价3及6个月患者神经功能恢复情况,分析影响患者转归的因素.结果 A组症状性颅内出血和病死率虽高于B组,但差异无统计学意义(21.3% vs 6.5%,19.1% vs 12.9%,P>0.05).B组预后明显好于A组,差异有统计学意义(P<0.01);2组3和6个月的预后良好率均有统计学差异(P<0.05).年龄、房颤、基线NIHSS评分、术前Qureshi分级、闭塞动脉部位为影响预后的因素,基线NIHSS评分是影响转归的保护性因素,房颤为转归不良的独立危险因素.结论 SolitaireAB支架取栓治疗房颤脑梗死急性期疗效肯定,远期预后较大动脉粥样硬化取栓患者差;房颤是转归不良的独立危险因素.

Objective To evaluate the effect of SolitaireAB stent thrombectomy on AF-induced ACI and risk factors for its poor outcome.Methods Seventy-eight ACI patients admitted to our hospital were divided into stent thrombectomy group as group A(n=47)and large atherosclerosis stent thrombectomy group as group B(n=31).The neural function and outcome of the patients were assessed according to their NIHSS score and mRS score respectively.The efficiency and safety of stent thrombectomy for AF-induced ACI were compared between the two groups. The survival cure was plotted for the assessment of neural function recovery at months 3 and 6 in two groups after operation.Results The outcome was significantly better in group B than in group A after operation(P <0.01).The rate of good outcome was significantly different in two groups at months 3 and 6 after operation(P <0.01).Age,AF,preoperative Qureshic grading,site of arterial occlusion were the risk factors for poor outcome while baseline NIHSS score was the protective factor for good outcome and AF was the independent risk factor for poor outcome in ACI patients.Conclusion Solitaire AB stent thrombectomy is effective for AF-induced ACI and is ineffective for the long-term outcome in large atherosclerosis patients.AF is the independent risk factor for poor outcome in ACI patients.