青年急性大血管闭塞性卒中病因及血管内治疗效果

Etiology and endovascular treatment of young patients with acute large vessel occlusive stroke

目的探讨青年急性大血管闭塞性卒中(ALVOS)病因及血管内治疗的安全性和有效性。方法回顾性分析2018年1月—2021年12月接受血管内治疗的40例青年ALVOS患者的临床资料,分析青年ALVOS的病因及接受血管内治疗的手术成功率和并发症发生情况,采用美国国立卫生研究院卒中量表(NIHSS)评分评估患者入院和出院时的神经功能。根据术后90 d时改良Rankin量表(mRS)评分将患者分为预后良好者(mRS评分≤2分)与预后不良者(mRS评分>2分),比较预后良好与预后不良患者临床资料以及患者基线时与出院时NIHSS评分。结果本研究共入组40例患者,其中男32例(80.0%),女8例(20.0%),年龄41.5(36.0,44.0)岁。按照急性卒中试验(TOAST)分型进行分类,大动脉粥样硬化(LAA)型18例(45.0%),心源性栓塞(CE)型12例(30.0%),其他原因(SOE)型8例(20.0%),不明原因(SUE)型2例(5.0%)。38例患者经血管内治疗成功再通,2例再通失败,未发生手术相关严重并发症。术后6例患者出现症状性颅内出血。出院时NIHSS评分为2.0(0.3,7.5)分,低于基线时的12.0(6.3,15.8)分,差异有统计学意义(P<0.05)。术后90 d随访,29例患者预后良好(mRS评分0~2分),死亡5例(mRS评分6分)。预后良好者、体质量指数(BMI)、手术时间、取栓次数、症状性颅内出血与预后不良者比较,差异有统计学意义(P<0.05)。结论青年ALVOS病因以LAA型和颈动脉夹层常见,血管内治疗对各种病因引起的青年ALVOS安全、有效,BMI、手术时间、取栓次数、症状性颅内出血可能影响青年ALVOS患者血管内治疗的预后。

Objective To investigate the the etiology of young adults with acute large vessel occlusion stroke(ALVOS)and its safety and effectiveness of endovascular treatment.Methods From January 2018 to December 2021,clinical data of 40 young patients with ALVOS were retrospectively analyzed.The etiology of young patients with ALVOS,the success rate and occurrence of complications of endovascular treatment were analyzed.The neurological function of the patients at admission and at discharge was evaluated using the National Institutes of Health Stroke Scale(NIHSS)score.According to the modified Rankin scale(mRS)score at 90 days after surgery,the patients were divided into good prognosis patients(mRS scored≤2)and poor prognosis patients(mRS scored>2).Clinical data of the patients with good prognosis and poor prognosis and the NIHSS score at baseline and at discharge were compared.Results A total of 40 patients were enrolled in this study.There were thirty-two males(80.0%)and eight females(20.0%).The age was 41.5(36.0,44.0)years.According to Trial of Org 10172 in Acute Stroke Treatment(TOAST)classification,there were 18 cases(45.0%)of large atherosclerotic type(LAA),12 cases(30.0%)of cardiac embolism(CE)type,8 cases(20.0%)of other causes(SOE)and 2 cases(5.0%)of unexplained causes(SUE)type.Thirty-eight patients resulted in successfully recanalization,and two patients failed,without serious complications.Six patients had symptomatic intracranial hemorrhage after operation.The NIHSS score at discharge was 2.0(0.3,7.5),which was lower than 12.0(6.3,15.8)at baseline(P<0.05).At 90 days of follow-up,29 patients achieved good outcome(mRS score 0 to 2),five patients died(mRS score 6).There were significant differences in the body mass index(BMI),operation time,times of thrombectomy and symptomatic intracranial hemorrhage between the good prognosis patients and the poor prognosis patients(P<0.05).Conclusion LAA type and carotid artery dissection are common causes of ALVOS in young adults.Endovascular treatment of ALVOS caused by various etiologies in young patients is safe and effective.BMI,operation time,times of thrombectomy,and symptomatic intracranial hemorrhage may affect the prognosis of endovascular treatment in young ALVOS patients.