Solumbra技术介入取栓后颅内出血转化的危险因素

Influencing Factors of Intracranial Hemorrhage after Thrombectomy with Solumbra Technique in Acute Ischemic Stroke

目的探究急性缺血性脑卒中(acute ischemic stroke,AIS)患者经支架联合负压抽吸(Solumbra)技术取栓后发生责任血管区颅内出血转化(hemorrhagic transformation,HT)的危险因素。方法收集2019年1月~2021年6月于徐州医科大学附属连云港医院采用Solumbra技术治疗的212例AIS患者的临床资料,其中颅内出血转化组50例,未出血组162例,比较两组患者临床资料的差异。计量资料分析采用t检验,计数资料分析采用χ2检验,并检验危险因素对取栓术后颅内出血的诊断价值。结果出血转化组发病年龄、发病至介入取栓时间、手术总时间、支架取栓操作次数均高于未出血组,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(OR=1.075,95%CI:1.034~1.117,P=0.001)、取栓次数(OR=1.877,95%CI:1.309~2.692,P=0.001)是AIS患者Solumbra技术取栓后发生颅内出血转化的危险因素。受试者工作特征曲线结果显示,年龄、支架取栓次数及二者联合预测术后颅内出血的曲线下面积分别是0.70、0.69、0.85,其敏感度分别为68.0%、50.0%、86.0%,特异性分别为65.0%、86.0%、70.6%,年龄、取栓次数的截断值分别是67.5岁、2.5次。Spearman相关分析显示,患者的责任血管位置、低白蛋白血症及高糖化血红蛋白水平与入院高NIHSS评分显著相关(P<0.05)。结论高龄AIS患者Solumbra技术下多次取栓可能增加术后颅内出血转化的风险。

Objective To explore the risk factors of intracranial hemorrhage in the responsible vascular area in patients with Acute ischemic stroke(AIS)after the therapy with Solumbra technology.Methods we collected the clinical data of 212 AIS patients who underwent intravascular interventional thrombectomy in the Affiliated Lianyungang Hospital of Xuzhou Medical University from January 2019 to June 2021.There were 50 cases of postoperative intracranial hemorrhage transformation(HT),and 162 cases of non-hemorrhage.The differences of clinical data between the two groups were compared.The data were analyzed by t-test andχ2 test.Results The age of onset in the bleeding group,the time from onset to interventional thrombectomy,the total operation time,and the number of stent thrombectomy operations were higher than those in non-bleeding group(P<0.05).Multivariate Logistic regression analysis showed that the age(OR=1.075,95%CI:1.034-1.117,P=0.001)and the number of stent thrombectomy operations(OR=1.877,95%CI:1.309-2.692,P=0.001)were the risk factors of intracranial hemorrhage in AIS patients after thrombectomy with Solumbra technology.Receiver operating characteristic curve results showed that the area under the curve(AUC)predicted by age,times of thrombectomy and their combination were 0.70,0.69,0.85.Their sensitivity were 68.0%,50.0%,86.0%respectively.The specificity were 65.0%,86.0%,70.6%respectively.The diagnostic cutoff value of age and the number of stent thrombectomy operations were 67.5 years old and 2.5.Spearman correlation analysis indicated that the location of responsible vessels,the level of hypoalbuminemia and hyperglycated hemoglobin were significantly correlated with the high NIHSS score.Conclusion The times of Intravascular thrombectomy under solumbra technology in elderly AIS patients may increase the risk of postoperative intracranial hemorrhage.