多模式影像在超时间窗前循环大血管闭塞脑梗死患者血管内治疗的应用研究

Multimodality imaging during EVT for cerebral infarction with LVO in the anterior circulation in patients beyond time window

目的 探讨多模式影像指导超时间窗前循环大血管闭塞(LVO)脑梗死患者血管内治疗(EVT)的临床疗效。方法 选取2018年3月至2022年3月我院神经内科行EVT的前循环LVO脑梗死患者74例,按照发病至股动脉穿刺时间(OPT)分成2组,窗内组(OPT≤6 h,包括静脉溶栓后直接桥接治疗、直接EVT的患者)45例和超窗组(醒后脑卒中或OPT>6 h)29例,比较2组患者3个月后病死率及预后良好率;按照3个月后改良的Rankin量表(mRS)评分分为2组,预后良好组(mRS评分≤2分)34例和预后不良组(mRS评分>2分)40例,分析影响预后的因素。结果 窗内组与超窗组3个月后病死率(15.6%vs 13.8%)、预后良好比例(46.7%vs 44.8%)比较无统计学差异(P>0.05)。窗内组OPT显著低于超窗组(P<0.01)。预后良好组OPT、基线美国国立卫生研究院卒中量表(NIHSS)评分显著低于预后不良组(P<0.01);2组血管再通、2型糖尿病、侧支循环比例比较,差异有统计学意义(P<0.05,P<0.01);多因素二元logistic回归分析显示,OPT(OR=1.005,95%CI:1.001~1.008,P=0.015)、基线NIHSS评分(OR=1.330,95%CI:1.027~1.723,P=0.030)、侧支循环情况较差和中等(OR=19.553,95%CI:2.971~128.697,P=0.002;OR=8.180,95%CI:1.270~52.673,P=0.027)是影响超时间窗前循环LVO脑梗死患者预后的因素。结论 在多模式影像指导下超时间窗前循环LVO脑梗死患者EVT安全可行,患者OPT越长、基线NIHSS评分越高、侧支循环越差,预后不良的风险越高。

Objective To evaluate the clinical efficacy of multimodality imaging-guided endovascular treatment(EVT) in patients with large vessel occlusion(LVO) beyond the time window.Methods From March 2018 to March 2022,74 patients with anterior circulation LVO cerebral infarction who underwent EVT were selected from our hospital.According to the time from onset to groin puncture(OPT),they were divided into in-window group(OPT ≤6 h, n=45,including direct bridging therapy after intravenous thrombolysis and direct EVT) and the beyond-window group(including wake-up stroke or OPT >6 h for EVT,n=29).The mortality rate and rate of good prognosis within 3 months were compared between the two groups.According to the result of mRS after 3 months, the patients were divided into good prognosis group(mRS score ≤2,n=34) and poor prognosis group(mRS score >2,n=40).The factors influencing prognosis were analyzed.Results There were no significant differences in the 3-month mortality(15.6% vs 13.8%) and rate of good prognosis(46.7% vs 44.8%) between the two groups(P>0.05).The OPT was significantly shorter in the in-window group than the beyond-window group(P<0.01).The OPT and NIHSS scores at baseline were significantly lower in the good prognosis group than the poor prognosis group(P<0.01),and obvious differences were seen in the proportions of vascular recanalization, type 2 diabetes mellitus and collateral circulation between the two groups(P<0.05,P<0.01).Multivariate binary logistic regression analysis showed that OPT(OR=1.005,95%CI:1.001-1.008,P=0.015),baseline NIHSS score(OR=1.330,95%CI:1.027-1.723,P=0.030),and poor and moderate collateral circulation(OR=19.553,95%CI:2.971-128.697,P=0.002;OR=8.180,95%CI:1.270-52.673,P=0.027) were prognostic factors of patients with LVO cerebral infarction beyond the time window.Conclusion EVT is safe and feasible in patients with LVO cerebral infarction beyond the time window.The longer OPT,higher baseline NIHSS score, and worse collateral circulation are associated with a higher risk of poor prognosis.