尝试取栓次数对机械血栓切除术后血管成功再通的急性缺血性卒中患者转归的影响

Effect of the number of retrieval attempts on the outcomes after successful recanalization of mechanical thrombectomy in patients with acute ischemic stroke

目的探讨尝试取栓次数对机械血栓切除术后血管成功再通的急性缺血性卒中患者转归的影响。方法回顾性纳入2019年1月至2020年5月在南京大学医学院附属鼓楼医院卒中中心接受机械血栓切除术且术后血管成功再通的急性大血管闭塞性缺血性卒中患者。根据术中尝试取栓次数将患者分为尝试取栓<3次组和尝试取栓≥3次组。比较两组人口统计学资料、手术相关指标、围手术期并发症及术后90 d转归。结果共纳入106例患者,年龄(69.8±1.3)岁,男性55例(51.9%)。尝试取栓<3次组83例(78.3%),尝试取栓≥3次组23例(21.7%)。90 d转归良好(改良Rankin量表评分≤2分)41例(38.7%),死亡11例(10.4%)。尝试取栓≥3次组颅内出血发生率(30.4%对20.5%;χ^(2)=1.019,P=0.313)以及90 d转归良好率(34.8%对39.8%;χ^(2)=0.188,P=0.665)和病死率(8.7%对10.8%;P=0.999)与尝试取栓<3次组相比均差异无统计学意义,但有症状颅内出血发生率显著高于尝试取栓<3次组(13.0%对1.2%;P=0.031)。多变量logistic回归分析提示,尝试取栓次数与患者转归不良无显著相关性。结论机械血栓切除术尝试次数较多可能与有症状颅内出血相关,但并不影响术后血管成功再通患者3个月时的临床转归。

Objective To investigate the effect of the number of retrieval attempts on the outcomes after successful recanalization of mechanical thrombectomy in patients with acute ischemic stroke.Methods Patients with acute large vessel occlusive ischemic stroke underwent mechanical thrombectomy and successful postoperative recanalization in the Stroke Center of Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from January 2019 to May 2020 were retrospectively enrolled.According to the number of retrieval attempts during the procedure,the patients were divided into<3-attempt group and≥3-attempt group.The demographic data,procedure-related indexes,periprocedural complications and outcomes at 90 d after the procedure were compared between the two groups.Results A total of 106 patients,aged 69.8±1.3 years,were enrolled,and 55 were males(51.9%).Eight-three patients(78.3%)were in the<3-attempt group,and 23(21.7%)were in the≥3-attempt group.Forty-one patients(38.7%)had good outcomes(the modified Rankin Scale score≤2)at 90 d,and 11(10.4%)died.There were no significant differences in the incidence of intracranial hemorrhage(30.4%vs.20.5%;χ^(2)=1.019,P=0.313),the good outcome rate at 90 d(34.8%vs.39.8%;χ^(2)=0.188,P=0.665)and mortality(8.7%vs.10.8%;P=0.999)between the≥3-attempt group and<3-attempt group,but the incidence of symptomatic intracranial hemorrhage was significantly higher than that in the<3-attampt group(13.0%vs.1.2%;P=0.031).Multivariate logistic regression analysis showed that the number of retrieval attempts was not significantly associated with poor outcome.Conclusion The more retrieval attempts may be related to symptomatic intracranial hemorrhage,but it does not affect the clinical outcomes of patients with successful recanalization at 3 months.