院内急性缺血性脑卒中机械取栓治疗效果和预后因素分析

Endovascular thrombectomy for in-hospital acute ischemic stroke: analysis of therapeutic effect and factors affecting prognosis

目的探讨机械取栓治疗院内急性缺血性脑卒中患者临床效果及其预后因素。方法回顾性分析2015年1月至2019年1月南京医科大学第一附属医院采用机械取栓治疗的连续院内急性缺血性脑卒中患者临床资料。主要观察指标为90 d改良Rankin量表(m RS)评分。根据90 d mRS评分将患者分为预后良好(mRS评分≤2)组和预后欠佳(mRS评分3~6)组。采用单因素和多因素logistic回归分析预测患者预后因素。结果共有34例院内急性缺血性脑卒中患者纳入本研究。基线美国国立卫生研究院卒中量表(NIHSS)评分为平均(19.1±8.9)分,发病至股动脉穿刺时间为平均(182.3±81.3)min。4例(11.8%)患者取栓前接受静脉溶栓治疗。29例(85.3%)患者闭塞血管获得成功再通。术后4例发生症状性脑出血。术后11例(32.4%)患者获90 d良好预后。90 d预后不佳更常见于合并冠心病患者(56.5%对9.1%,χ2=6.911,P=0.011)。单因素和多因素logistic回归分析显示冠心病是预后不良的独立预测因素(OR=0.08,95%CI=0.01~0.08,P=0.031)。结论机械取栓治疗院内急性缺血性脑卒中患者安全有效。冠心病可能是预后不佳的独立危险因素。

Objective To evaluate the therapeutic effect and prognostic factors of endovascular thrombectomy(EVT) for in-hospital acute ischemic stroke and to analyze the factors affecting prognosis.Methods The clinical data of 34 consecutive patients with in-hospital acute ischemic stroke, who were hospitalized at the First Affiliated Hospital of Nanjing Medical University of China and received EVT during the period from January 2015 to January 2019, were retrospectively analyzed. The main observation index was post-EVT 90-d modified Rankin scale(mRS) score. Based on the post-EVT 90-d m RS score, the patients were divided into good prognosis group(mRS score≤2 points) and poor prognosis group(m RS score 3-6 points).Univariate and multivariate logistic regression analysis were used to analyze the factors predicting patient’s prognosis. Results A total of 34 patients with in-hospital acute ischemic stroke were enrolled in this study.The average baseline National Institutes of Health Stroke Scale(NIHSS) score was(19.1±8.9) points. The time interval from symptom onset to femoral artery puncturing was(182.3±81.3) min. Four patients(11.8%)received intravenous thrombolytic therapy before EVT. Successful recanalization of obstructed vessels was achieved in 29 patients(85.3%). After EVT, 4 patients developed symptomatic intracranial hemorrhage. Post-EVT90-d good prognosis was obtained in 11 patients(32.4%). Post-EVT 90-d poor prognosis was more commonly seen in patients with coronary heart disease(56.5% versus 9.1%, χ2=6.911, P=0.011). Univariate and multivariate logistic regression analyses showed that coronary artery disease was the independent factor predicting poor prognosis(OR=0.08, 95%CI=0.01-0.08, P=0.031). Conclusion For the treatment of patients with in-hospital acute ischemic stroke, EVT is safe and effective. Coronary artery disease may be an independent factor predicting poor prognosis.