大动脉粥样硬化性和心源性急性后循环大血管闭塞患者血管内治疗的疗效对比研究

Comparative study of endovascular therapy in patients with large artery atherosclerosis and cardiogenic acute posterior circulation occlusion

目的通过收集急性后循环卒中患者的临床资料,对比分析TOAST分型为大动脉粥样硬化性(Large artery atherosclerosis,LAA)和心源性(Cardioembolism,CE)卒中患者经血管内治疗后的疗效差异。方法患者数据来源于石河子大学医学院第一附属医院国家高级卒中中心,根据TOAST分型,将纳入的98人分为LAA组和CE组,使用mTICI评分评价血管再通情况、90 d mRS评分评价患者预后、术后72 h内颅内出血转化发生率及90 d卒中相关病死率评估血管内治疗安全性。结果纳入研究的98例患者中,79人为LAA卒中患者,19人为CE患者。与CE患者相比,LAA卒中患者的年龄更小(60.08±12.64 vs 71.05±10.42,P=0.001),高血脂患病率更高(55.7%vs 22.1%,P=0.014),术前收缩压更高(149.25±21.24 vs 134.79±22.83,P=0.010),NIHSS评分更低(17.3 vs 22.2,P=0.025),侧支循环更好(ASITN/SIR评分为2~4的比例,63.3%vs 21.1%,P=0.002),血管成形率更高(31.6%vs 5.3%,P=0.040)。然而,两组患者EVT血管再通率(87.5%vs 84.2%,P=1.000),90 d神经功能恢复良好(mRS评分为0~2)的比例(58.2%vs 36.8%,P=0.093),术后颅内出血转化发生率(1.3%vs 0%,P=1.000)以及90 d卒中相关病死率(20.3%vs 42.1%,P=0.091)均无统计学意义。结论后循环LAA和CE急性脑梗死患者虽然在基线临床资料和EVT临床特征上存在差别,但预后无明显差异。

Objective In this study,the clinical data of single-center acute posterior circulation stroke patients were analyzed to compare the efficacy of TOAST classification for large artery atherosclerosis(LAA)and cardioembolism(CE)stroke patients after intravascular treatment difference.Methods Patient data comes from the advanced stroke center of the First Affiliated Hospital of Shihezi University School of Medicine,Xinjiang,China.According to the TOAST classification,the 98 people included were divided into LAA group and CE group.The mTICI score was used to evaluate vascular recanalization,the 90 day mRS score was used to evaluate the prognosis,the incidence of intracranial hemorrhage conversion within 72 hours and 90 day mortality Assess the safety of intravascular treatment.Results Among the 98 patients included in the study,79 were LAA stroke patients and 19 were CE patients.Compared with CE patients,LAA stroke patients are younger(60.08±12.64 vs 71.05±10.42,P=0.001),have a higher prevalence of hyperlipidemia(55.7%vs 22.1%,P=0.014),and preoperative systolic blood pressure higher(149.25±21.24 vs 134.79±22.83,P=0.010),lower NIHSS score(17.3 vs 22.2,P=0.025),better collateral circulation(ASITN/SIR score of 2~4 ratio,63.3%vs 21.1%,P=0.002),the angioplasty rate is higher(31.6%vs 5.3%,P=0.040).However,the EVT recanalization rate(87.5%vs 84.2%,P=1.000)of the two groups of patients,the 90 day neurological function recovery rate(mRS score 0~2)(58.2%vs 36.8%,P=0.093),The incidence of postoperative intracranial hemorrhage transformation(1.3%vs 0%,P=1.000)and the 90 day stroke-related mortality(20.3%vs 42.1%,P=0.091)were not statistically significant.Conclusions Although there were differences in baseline clinical data and clinical characteristics of EVT treatment between LAA and CE in posterior circulation,there was no significant difference in prognosis.