低灌注强度比值对前循环大血管闭塞急性缺血性脑卒中血管内取栓治疗预后的预测价值

Prognostic value of hypoperfusion intensity ratio in acute ischemic stroke with large vessel occlusion of anterior circulation after endovascular thrombectomy

目的探讨低灌注强度比值(HIR)对前循环大血管闭塞急性缺血性脑卒中(AIS-LVO)患者血管内取栓治疗预后的预测价值。方法回顾性分析2019年1月至12月在我院脑血管病中心接受血管内取栓治疗的前循环AIS-LVO患者的资料。根据HIR将患者分为侧支循环良好(HIR<0.4)组和侧支循环不良(HIR≥0.4)组,比较两组患者的临床资料。根据术后90 d改良Rankin量表(mRS)评分将患者分为预后良好(mRS评分≤2分)组和预后不良(mRS评分为3~6分)组,比较两组患者的临床资料和影像学特征,并采用多因素logistic回归分析确定治疗后90 d预后的影响因素。结果共120例患者纳入研究,其中侧支循环良好组41例、侧支循环不良组79例,预后良好组68例、预后不良组52例。与侧支循环良好组相比,侧支循环不良组患者年龄偏大、核心梗死体积较大、基线美国国立卫生研究院卒中量表(NIHSS)评分较高、Alberta脑卒中计划早期计算机断层扫描评分(ASPECTS)较低,差异均有统计学意义(P均<0.05)。与预后良好组相比,预后不良组的患者年龄偏大、男性患者占比较低、基线NIHSS评分较高、核心梗死体积较大、ASPECTS较低、血管成功再通率较低、术后sICH发生率较高且HIR较高,差异均有统计学意义(P均<0.05)。多因素logistic回归分析显示,年龄>80岁(OR=2.290,95%CI 1.077~4.869,P=0.031)、HIR≥0.4(OR=2.974,95%CI 1.060~8.342,P=0.038)是前循环AIS-LVO患者血管内取栓治疗后90 d预后不良的独立预测因素。结论HIR是一个可靠的术前侧支循环评价指标,高龄、HIR≥0.4是预测前循环AIS-LVO患者血管内取栓治疗后90 d预后不良的独立因素。

Objective To investigate the predictive value of hypoperfusion intensity ratio(HIR)on the prognosis of patients with acute ischemic stroke with large vessel occlusion(AIS-LVO)of anterior circulation after endovascular thrombectomy.Methods The data of anterior circulation AIS-LVO patients treated with endovascular thrombectomy in Neurovascular Center of our hospital from Jan.to Dec.2019 were retrospectively analyzed.The patients were divided into good collateral circulation(HIR<0.4)group and poor collateral circulation(HIR≥0.4)group.The clinical data of the 2groups were compared.According to the modified Rankin scale(m RS)score 90 d after operation,the patients were divided into good prognosis(m RS score≤2)group and poor prognosis(m RS score 3-6)group.The clinical and imaging data of the 2groups were compared.The influencing factors of the prognosis 90 d after operation were determined by multivariate logistic regression analysis.Results Totally 120 patients were included,including 41 patients in the good collateral circulation group and 79 in the poor collateral circulation group;and 68 in the good prognosis group and 52 in the poor prognosis group.The patients in the poor collateral circulation group were older,and had larger core infarction volume,higher baseline National Institutes of Health stroke scale(NIHSS)score and lower Alberta Stroke Program early computed tomography score(ASPECTS)compared with the patients in the good collateral circulation group,with significant differences(all P<0.05).The patients in the poor prognosis group were older,with more females,and had higher baseline NIHSS score,larger core infarction volume,lower ASPECTS and successful vascular recanalization rate,and higher incidence of postoperative s ICH and HIR compared with the patients in the good prognosis group,with significant differences(all P<0.05).Multivariate logistic regression analysis showed that age>80 years(odds ratio[OR]=2.290,95%confidence interval[CI]1.077-4.869,P=0.031)and HIR≥0.4(OR=2.974,95%CI 1.060-8.342,P=0.038)were independent predictors of poor prognosis of patients with anterior circulation AIS-LVO 90 d after endovascular thrombectomy.Conclusion HIR is a reliable measure of collateral circulation before operation.Advanced age and HIR≥0.4 are independent predictors of poor prognosis of patients with anterior circulation AIS-LVO 90 d after endovascular thrombectomy.