血栓负荷量对大血管闭塞性卒中急诊血管内再通治疗预后的影响

Effect of thrombotic burden on the clinical outcome of endovascular recanalization in large vessel occlusion stroke

目的探讨血栓负荷量对大血管闭塞性卒中血管内再通治疗预后的影响。方法回顾性分析自2018年1月至2019年12月郑州大学人民医院发病在24 h内前循环大血管闭塞62例患者的影像和临床资料,所有患者均进行急诊血管内治疗,根据DSA的血栓负荷量评分(CBS)分为CBS≥6分组(24例)和CBS<6分组(38例),采用改良Rankin量表(mRS)评分评估术后90 d的临床预后,采用独立样本t检验、Wilcoxon秩和检验及χ^(2)检验比较2组临床资料。采用二元logistic回归分析影响临床预后的独立危险因素。结果CBS≥6分组和CBS<6分组在基本人口资料、脑卒中的高危因素等比较差异无统计学意义(P>0.05);CBS≥6分组术后应用盐酸替罗非班比率(63.2%,24/38)低于CBS<6组(87.5%,21/24)(χ^(2)=4.380,P=0.044),CBS≥6组出院NIHSS评分为[5.0(3.3,7.8)分]低于CBS<6组[8.5(1.8,14.5)分](Z=5.221,P=0.022),术后90 d mRS为0~2分CBS≥6组比率(91.7%,22/24)高于CBS<6组(39.5%,15/38)(χ^(2)=20.486,P=0.001)。二元logistic回归分析结果提示,CBS分组[OR=0.042,95%CI 0.007~0.244,P=0.001]是影响良好预后的独立危险因素。对是否应用替罗非斑组进行亚组分析,在临床预后方面,2组之间的差异无统计学意义(P>0.05)。结论CBS≥6分组的临床预后明显优于CBS<6分组,即血栓负荷量小的患者更易获得90 d的良好预后。

Objective To investigate the effect of thrombus burden on the clinical outcome of endovascular recanalization in large vessel occlusive stroke.Methods Patients with acute anterior circulation occlusion who underwent endovascular treatment within 24 hours after onset in Zhengzhou University People′s Hospital from January 2018 to December 2019 were retrospectively collected.According to the clot burden score(CBS)of DSA,total objectives were divided into CBS≥6 group(24 cases)and CBS<6 group(38 cases).Clinical data of the two groups were collected and the modified Rankin scale(mRS)was used to evaluate the clinical outcome at 90 days after surgery.Independent sample t-test,Wilcoxon rank sum test andχ^(2) test were used to compare the clinical data between the two groups.Independent risk factors affecting the clinical outcome were analyzed by binary logistic regression.Results There were no statistically significant differences in basic demographic data,stroke risk factors and other factors between the CBS≥6 group and CBS<6 group(P>0.05).The proportion of using tirofiban after surgery in the CBS≥6 group(63.2%,24/38)was lower than that in the CBS<6 group(87.5%,21/24)(χ²=4.380,P=0.044).The discharge NIHSS score of the CBS≥6 group was[5.0(3.3,7.8)points]lower than CBS<6 group[8.5(1.8,14.5)points](Z=5.221,P=0.022).The proportion of postoperative mRS 0-2 was(91.7%,22/24)in the CBS≥6 group higher than CBS<6 group(39.5%,15/38)(χ²=20.486,P=0.001),there were no statistically significant differences between the two groups(P<0.05).The results of binary logistics regression analysis showed the CBS groups(OR=0.042,95%CI 0.007-0.244,P=0.001)was an independent risk factor affecting good outcome.Subgroup analysis of whether tirofiban was used or not showed there was no statistically significant difference in clinical prognosis between the two groups(P>0.05).Conclusions The clinical outcome of CBS≥6 group is significantly better than that of CBS<6 group,and patients with small thrombus burden are more likely to get a good clinical outcome of 90 days.