SWIM技术治疗急性大脑中动脉M1段闭塞患者首次血管再通的影响因素分析

Factors influencing the first recanalization of acute occlusion of M1 segment of middle cerebral artery in SWIM technology

目的探讨应用SWIMI技术治疗大脑中动脉M1段闭塞的急性缺血性脑卒中(AIS)患者实现闭塞血管首次再通的影响因素。方法回顾分析2017年2月至2019年11月在浙江医院卒中中心应用SWIM技术进行血管内治疗的急性大脑中动脉M1段闭塞并最终实现血管再通患者的临床资料。记录患者的性别、年龄、基础疾病、有无吸烟史、血脂水平、入院时及术后7d美国国立卫生研究院卒中量表(NHSS)评分、改良Rankin量表(mRS)评分、支架打开后锚定远端M2段血管的直径及其是否为优势主干,根据mRS评分评价患者术后90d预后情况。根据改良脑梗死溶栓分级(mTICI)将入组患者分为首次再通组和非首次再通组,采用单因素分析比较两组间各指标的差异,并分析各因素与血管首次再通的相关性。结果共纳入64例患者,其中血管首次再通29例,非首次再通35例。两组患者的性别、年龄以及高血压、糖尿病、高脂血症、有吸烟史、缺血性心脏病、心房颤动所占比例比较差异均无统计学意义,两组术后7d NIHSS评分均较术前有所改善,首次再通组治疗前后的NIHSS评分差值明显高于非首次再通组(分:9.33±2.39比7.70±2.85.P<0.05).首次再通组患者90d预后良好率略高于非首次再通组,但差异无统计学意义[68.9%(20/29)比51.4%(18/35).P>0.05]。与非首次再通组比较,首次再通组支架远端错定优势主干所占比例明显升高[(75.9%(22/29)比42.9%(15/35)].支架远端错定血管直径明显增大[mm:1.70(1.58.1.90)比1.50(1.32.1.73)].差异均有统计学意义(均P<0.05)。相关性分析显示,支架远端锚定优势主干、支架锚定M2段血管直径均与闭塞血管首次再通,呈正相关(Kenall's tau-b相关系数分别为0.333、0.276.P值均为0.008)。结论在利用SWIM技术治疗大脑中动脉M1段闭塞的AIS患者中,支架远端锚定优势主干和支架锚定M2段血管直径与闭塞血管首次再通相关。

Objective To investigate the influencing factors of realizing the first reanalization of arute ischemic stroke(AIS)patients with MI srgment orrlusion of middle crebral artery trated by mechanical thrombertomy(SWIMI)teehunolongy.Methods The clinical data of patients with acute MI segment ocelusion of middle cerebral artery admitted into the stroke center of Zhejiang Hospital from February 2017 to November 2019 and treated by SWIM lerhnology to rarry oul intra-vascrular therapy for the orrlusion and finally realizing the reranalization were retrospertively analyzel.The patiernts'age.gender,underly ing disrase,smoking history,blool lipid level.American National Institute of Health stroke sraler(NIHSS)srores on admission and the 7th day after operation.modifed Rankin sreale(mRS)score.the diameter of distal M2 srgment vessel anehored hy an openerd stent and differentiating whether it being a superior major Irunk were rrorded.and acording 1o mRS srore.patienls'posl-operative 90-day prognoses were evaluated.Arorling to the modified gradation of cerebral infaretion thrombolysis(mTICI).the enollerd patiernts wer divided into 2 groups:the first reanalization group and the non-fist reranalization group.Singlr fartor analysis was used to compare the diflfenre of rach indirator helween the 1wo groupr,and the correlation between earh factor and the first vascular reeanalization was analyred.Results A total of 64 patients were erolled,ineluding 29 rases with first reanalizaion and 35 cases with non-first reranalizaion.The dffrenrers in gender.age.and hypertension,diabeter,hyperlipidemia.smoking histoy.ischemie heart disease.atrial fibilltion proportion between the two groups of patiernts had no statistical significance:compared with the srores before operation.the pustoperative 7-day NIHSS srorrs of both group after treatment were improverd.and the difference in NIHSS sorores before and after operation in the first recanalization group wias obn iously higher than that in the non-finst reranalization group(srore:9.33±2.39 vs.7.70±2.85.P<0.05).The rate of 90-day good prognosis in the firsl reranalization group was slightly higher than that in the non-first reranalization group.but the dfferenre was not saistitally significant[68.99(20/29)vs.51.4%(18/35).P>0.05].Compared with the non-first reranalization group.the proportion of sperior major lnunk anchorerd by an operned sternt at distal vessrl wias significantly higher in the first reeanalization group 175.9%(22/29)vs.42.9%(15/35)and the diameter of distal vessel anchored by an opernerd stent was also signifcanly larger in the first reamalization group [mm:1.70(1.58.1.90)vs.1.50(1.32.1.73)]with satistirally significant ifrenrrs(hoth P<0.05).Correlation analysis showerd that therr were positive correlations bertween the first reranalization of oreluded vessel and the suprior major tnunk of distal stent anchoring.and the diameter of M2 segment of stent anchoring(Kendall's tau-b correlation cneficients were 0.333 and 0.276.respertively.both P=0.008).Conclusion In AIS patients with MI srgment midle cerebral atery orclusion treated bhy SI IM tehnology.the superior tnunk of distal stent anchoring and the diameter of M2 segment of stent anchoring are correlated with the first reeanalization of oreluded vessel.