急诊颈动脉支架置入对前循环串联病变预后的影响

Effect of Emergency Carotid Stent Placement on Prognosis of Patients with Anterior Circula⁃tion Tandem Lesions

目的:分析置入颈动脉支架对串联病变血管内治疗预后的影响。方法:收集2014年1月1日至2020年10月31日在湖北省第三人民医院神经内科行急诊血管内治疗的前循环大血管闭塞患者287例,其中串联病变51例(17.77%)。根据是否急诊置入颅外颈动脉支架,将串联病变患者分为支架组23例和非支架组28例。比较2组的一般资料、治疗方法和预后。结果:与非支架组比较,支架组的高血压、房颤、吸烟比例更高;基线美国国立卫生研究院卒中量表(NIHSS)评分和静脉溶栓治疗率更低,差异有统计学意义(P<0.05);而2组的性别、年龄、糖尿病、高脂血症、冠心病、Alberta卒中项目早期CT评分(ASPECTS)、发病至入院时间、入院至穿刺时间、入院至再通时间、取栓次数、良好再通、症状性颅内出血、良好预后及死亡情况差异无统计学意义(均P>0.05)。Logistic回归分析显示基线NIHSS评分(OR=0.835,P=0.038)可能是影响置入支架的因素。结论:急诊颈动脉支架置入不影响串联病变患者的临床预后,也不增加患者的手术风险。

Objective:To analyze the effect of simultaneous carotid stent placement on the prognosis of patients with anterior circulation tandem lesions.Methods:The clinical data of 287 patients with acute anterior circulation large vessel occlusion who underwent endovascular treatment were collected,in which 51 cases(17.77%)were anterior circulation tandem lesions.Patients were divided into the stent placement group(23 cases)and non-stent placement group(28 cases)according to whether the carotid artery stent was placed in an emergency.The general patient data,treatment,and prognosis were compared between the 2 groups.Results:Compared to the non-stent placement group,the stent placement group had a higher proportion of patients with hypertension,atrial fibrillation,and smoking;the stent placement group showed a lower baseline NIHSS score and lower rate of intravenous thrombolysis treatment,and the difference was statistically significant(P<0.05).There was no statistical difference between the 2 groups in terms of sex,age,diabetes,hyperlipidemia,coronary heart disease,Alberta stroke program early CT score(ASPECTS),time between onset and hospitalization,time between hospitalization and puncture,time between hospitalization and recanalization,number of thrombectomies,successful recanalization rate,symptomatic intracranial hemorrhage,good prognosis,and death(all P>0.05).Multivariate regression analysis showed that the NIHSS score(OR=0.835,P=0.038)was a relevant factor of emergency stent placement.Conclusion:Emergency carotid stent placement does not affect the clinical prognosis of patients with tandem lesions and does not increase surgical risk.