前循环卒中患者血管内机械血栓切除术后90 d死亡的预测因素

Predictors of 90 d death after endovascular mechanical thrombectomy in patients with anterior circulation stroke

目的探讨急性前循环大动脉闭塞性卒中机械血栓切除术后90 d死亡风险的危险因素。方法回顾性纳入2015年10月至2018年3月在上海市浦东新区人民医院和苏州大学附属第二医院行机械血栓切除术的急性前循环大动脉闭塞性卒中患者。主要终点事件定义为术后90 d内病死率。应用单变量和多变量logistic回归模型确定术后90 d内死亡的独立危险因素。结果总共纳入116例患者,其中23例(19.8%)在术后90 d内死亡。单变量分析显示,死亡组年龄、基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分、阿尔伯塔卒中项目早期CT评分(Alberta Stroke Program Early CT Score, ASPECTS)以及基线NIHSS评分分类( ≤8分、9~15分、≥16分)、ASPECTS≤7分、尝试通过次数>3次、改良脑梗死溶栓(modified Thrombolysis in Cerebral Infarction, mTICI)血流分级2b/3级、出血性转化(hemorrhagic transformation, HT)、有症状HT的患者构成比与存活组差异有统计学意义(P均<0.05)。多变量分析显示,校正年龄、空腹血糖、基线NIHSS评分、尝试通过次数>3次、mTICI 2b/3级后,ASPECTS较低[优势比(odds ratio,OR)0.647,95%可信区间(confidence interval,CI)0.456~0.917;P=0.014]、发病至血管再通时间较长(OR 1.004,95%CI 1.000~1.007;P=0.046)和有症状HT(OR 13.522,95%CI 2.719~67.258;P=0.001)是90 d内死亡的独立预测因素。结论 ASPECTS、发病至血管再通时间和有症状HT是急性前循环大动脉闭塞性卒中患者机械血栓切除术后90 d内死亡的独立危险因素。

Objective To investigate the risk factors for 90 d death after endovascular mechanical thrombectomy(MT)in patients with acute anterior circulation large-artery occlusive stroke.Methods From October 2015 to March 2018,patients with acute anterior circulation large-artery occlusive stroke treated with MT in People's Hospital of Shanghai Pudong New Area and the Second Affiliated Hospital of Soochow University were enrolled retrospectively.The primary outcome events were defined as death within 90 d after operation.Univariate and multivariate logistic regression models were used to identify the independent risk factors for death within 90 d after operation.Results A total of 116 patients were enrolled,23(19.8%)of them died within 90 d after operation.Univariate analysis showed that there were significant differences in age,baseline National Institutes of Health Stroke Scale(NIHSS)score,the Alberta Stroke Program Early CT Score(ASPECTS),and the proportion of the baseline NIHSS score classification(≤8,9-15,≥16),ASPECTS≤7,the number of attempts to pass>3 times,modified Thrombolysis in Cerebral Infarction(mTICI)blood flow grade 2b/3,hemorrhagic transformation(HT),and symptomatic HT in the death group compared with the survival group(all P<0.05).Multivariate analysis showed that after adjusting for age,fasting blood glucose,baseline NIHSS score,number of attempts to pass>3,and mTICI grade 2b/3,lower ASPECTS(odds ratio[OR]0.647,95%confidence interval[CI]0.456-0.917;P=0.014),longer time from onset to vascular recanalization(OR 1.004,95%CI 1.000-1.007;P=0.046)and symptomatic HT(OR 13.522,95%CI 2.719-67.258;P=0.001)were the independent predictors of death within 90 d.Conclusion The ASPECTS,time from onset to recanalization,and symptomatic HT were the independent risk factors for death within 90 d after MT in patients with acute anterior circulation large-artery occlusive stroke.