急性大血管闭塞性卒中机械取栓术后对比剂外渗的影响因素研究

Study on the influencing factors of contrast extravasation after mechanical thrombectomy in acute great vascular occlusive stroke

目的研究急性大血管闭塞性卒中(ALVOS)机械取栓术后对比剂外渗患者的临床特点、预后及其影响因素。方法收集2018年1月至2020年2月成都大学附属医院卒中中心确诊为ALVOS、经机械取栓术血管成功再通的患者52例,分为无对比剂外渗组(22例)和对比剂外渗组(30例)。统计2组患者的基线信息、围手术期参数及术后90 d预后情况。结果2组患者入院前阿尔伯塔早期卒中CT评分、从发病到血管再通的时间、从动脉穿刺到再通的时间及术后90 d改良Rankin量表评分比较差异有统计学意义(P<0.05)。多因素分析显示出血转化是对比剂外渗的独立危险因素(OR=7.016,95%CI:0.021~0.957,P=0.045)。结论出血转化是影响机械取栓术后造影剂外渗的独立危险因素;ALVOS患者入院CT显示低密度灶,发病后就诊时间长,院内血管再通时间长,可导致机械取栓术后对比剂外渗,提示卒中后预后不良。

Objective Patients suffering acute large vascular occlusion(ALVOS)combined with contrast extravasation after mechanical thrombectomy were collected to investigate the clinical characteristics,influencing factors and prognosis.Methods Fifty-two patients which were confirmed ALVOS by Stroke Center of Affiliated Hospital of Chengdu University from January 2018 to February 2020 and successfully recanalized by mechanical thrombectomy were divided into two groups:non-contrast extravasation group(n=22)and contrast extravasation group(n=22).Baseline information,perioperative parameters and prognosis in 90 d after operation were analysed.Results There were significant differences between the two groups in terms of the alberta stroke program early CT score,onset to revascularization time,puncture to revascularization and modified Rankin scale scores at 90 d after surgery(P<0.05).Multi-factor analysis showed that bleeding transformation was an independent risk factor for contrast agent extravasation(OR=7.016,95%CI:0.021-0.957,P=0.045).Conclusion Bleeding transformation is an independent risk factor for contrast agent extravasation after mechanical thrombectomy.ALVOS patients admitted to the hospital showed low-density lesions on CT,long visit time after onset,and long recanalization time of blood vessels in the hospital,which can lead to extravasation of contrast agent after mechanical thrombectomy,suggesting a poor prognosis after stroke.