急性前循环大血管闭塞性脑卒中血管内治疗的预后影响因素分析

Analysis of prognostic factors influencing endovascular treatment of acute anterior circulation large-vessel occlusive stroke

目的探讨急性前循环大血管闭塞性脑卒中血管内治疗的预后影响因素。方法回顾性分析2017年11月至2019年11月在沈阳医学院附属中心医院神经外科接受血管内治疗的急性前循环大血管闭塞性脑卒中病例57例,收集患者年龄、性别等基本资料,记录患者血压、血糖、术前是否溶栓、发病到溶栓及动脉取栓时间。术前进行基线美国国立卫生研究院卒中量表评分(NIHSS)、Alberta卒中项目早期计算机断层扫描评分(ASPECTS)、侧支循环情况评估,记录术后血管再通、抗血小板药物治疗情况及麻醉方式。根据术后90 d改良Rankin评分量表(m RS)评分将患者分为预后良好组和预后不良组。根据患者术后CT/MRI结果分为非症状性颅内出血组和有症状性颅内出血组,比较2组患者相关临床资料,分析影响预后的因素。结果预后良好组患者ASPECTS评分、侧支循环等级及术后血管再通比例均高于预后不良组(P<0.01),入院NIHSS评分和发病到取栓时间均低于预后不良组(P<0.01)。ASPECTS评分高、侧支循环良好、血管成功再通是良好预后的保护因素;而发病到取栓时间长是预后不良的危险因素。有症状性出血组患者年龄、术前溶栓比例以及血管再通比例均高于非症状性出血组(P<0.05)。术前溶栓和术后抗血小板药物治疗是症状性出血的危险因素。结论基线ASPECTS和NIHSS评分、术前溶栓、抗血小板药物、侧支循环和血管再通情况及发病到取栓时间均影响急性前循环大血管闭塞性脑卒中血管内治疗的预后。

Objective To investigate the prognostic factors of endovascular treatment of acute anterior circulation large-vessel occlusive stroke.Methods A retrospective analysis of 57 patients with acute precirculatory large-vessel occlusive stroke who underwent endovascular treatment in the Department of Neurosurgery,Central Hospital Affiliated To Shenyang Medical College,from November 2017 to November 2019.Basic information such as patient age and gender was collected,and blood pressure,blood glucose,whether preoperative thrombolysis was performed,and time from onset to arterial thrombectomy were recorded.The National Institutes of Health Stroke Scale(NIHSS)score,Alberta Stroke Project Early Computed Tomography(ASPECTS)score,collateral circulation,vascular recanalization,antiplatelet status,and anesthesia use were recorded after surgery.The patients were divided into good and poor prognosis groups based on the 90-day modified Rankin Scale score.According to postoperative computed tomography and magnetic resonance imaging,the patients were divided into the asymptomatic intracranial hemorrhage group and symptomatic intracranial hemorrhage group.The clinical data of the two groups were compared and the factors affecting the prognosis of endovascular treatment of acute anterior circulation macrovascular occlusive stroke were compared.Results Patients with good prognosis had higher ASPECTS scores and collateral circulation grade,and postoperative recanalization rates than those with a poor prognosis(P<0.01)as well as lower NIHSS scores and shorter time from onset to arterial thrombectomy(P<0.01)than those with a poor prognosis.A high ASPECTS score,good collateral circulation,and successful recanalization of the blood vessels were protective factors for good prognosis;prolonged time from onset to arterial thrombectomy were risk factors for poor prognosis.Older patients tended to have preoperative thrombolysis,while those with symptomatic hemorrhage had a higher postoperative recanalization rate than those with non-symptomatic hemorrhage(P<0.05).Preoperative thrombolysis and postoperative antiplatelet therapy are risk factors for symptomatic bleeding.Conclusion ASPECTS and NIHSS scores,preoperative thrombolysis,antiplatelet drug use,collateral circulation and vascular recanalization,and time from onset to thrombectomy affect the prognosis of endovascular treatment of acute anterior circulation macrovascular occlusive stroke.