血管内机械取栓术治疗急性基底动脉闭塞性卒中预后及其影响因素分析

Prognosis and Influencing Factors of Endovascular Mechanical Thrombectomy for Acute Basilar Artery Occlusive Stroke

目的:探讨血管内机械取栓术治疗急性基底动脉闭塞性卒中患者的预后及其影响因素。方法:选取本院2018年1月-2021年3月收治的接受血管内机械取栓术治疗的急性基底动脉闭塞性卒中患者54例。记录患者基线资料、诊疗情况,治疗3个月后评估患者的预后,将患者分为预后良好组及预后不良组。分析不同指标对患者预后的影响。结果:54例患者中,48例(88.89%)患者血管再通,12例(22.22%)患者死亡,29例(53.70%)患者预后良好,25例(46.30%)患者预后不良。两组年龄、性别、既往病史、吸烟、饮酒、TOAST分型、基底动脉闭塞部位、rt-PA静脉溶栓及症状性颅内出血发生率比较,差异均无统计学意义(P>0.05);与预后不良组比较,预后良好组入院NIHSS评分低、侧支循环良好率高、发病至入院时间及发病至再通时间均较短,差异均有统计学意义(P<0.05)。预后良好组血管再通率高于预后不良组,术后24 h NIHSS评分低于预后不良组(P<0.05)。logistic回归分析显示,入院及术后24 h NIHSS评分、发病至入院时间、发病至再通时间为预后不良的危险因素,而侧支循环良好、血管再通为保护因素(P<0.05)。结论:血管内机械取栓术治疗急性基底动脉闭塞性卒中血管再通率较高,入院及术后24 h NIHSS评分、发病至入院时间、发病至再通时间为预后不良的危险因素,而侧支循环良好、血管再通为保护因素。

Objective:To investigate the prognosis and influencing factors of endovascular mechanical thrombectomy for acute basilar artery occlusion stroke.Method:A total of 54 patients with acute basilar artery occlusive stroke treated by intravascular mechanical thrombectomy in our hospital from January 2018 to March 2021 were selected.Baseline data and diagnosis and treatment were recorded.After 3 months of treatment,the patients’ prognosis was evaluated,and they were divided into good prognosis group and poor prognosis group.The effects of different indexes on the prognosis of patients were analyzed.Result:Among the 54 patients,48 cases (88.89%) had vascular recanalization,12 cases (22.22%) died,29 cases (53.70%) had good prognosis and 25 cases (46.30%) had poor prognosis.There were no significant differences in age,sex,past medical history,smoking,drinking,TOAST classification,basilar artery occlusion,rt-PA intravenous thrombolysis and symptomatic intracranial hemorrhage between the two groups (P>0.05).Compared with the poor prognosis group,the good prognosis group had lower NIHSS score at admission,higher rate of good collateral circulation,shorter time from onset to admission and from onset to recanalization,the differences were statistically significant (P<0.05).The vascular recanalization rate in the good prognosis group was higher than that in the poor prognosis group,and the NIHSS score 24 h after operation was lower than that in the poor prognosis group (P<0.05).logistic regression analysis showed that NIHSS scores at admission and 24 h after operation,time from onset to admission and time from onset to recanalization were risk factors for poor prognosis,while good collateral circulation and vascular recanalization were protective factors (P<0.05).Conclusion:Intravascular mechanical thrombectomy has a high rate of vascular recanalization in the treatment of acute basilar artery occlusive stroke,NIHSS scores at admission and 24 h after operation,time from onset to admission and time from onset to recanalization are risk factors for poor prognosis,while good collateral circulation and vascular recanalization are protective factors.