老年急性前循环缺血性脑卒中血管内治疗成功再通患者90天内死亡的危险因素分析

Risk factors analysis of 90-day death in elderly with anterior circulation AIS undergoing endovascular treatment with successful recanalization

目的分析老年急性前循环缺血性脑卒中血管内治疗成功再通患者90 d内死亡的危险因素。方法回顾性选取2016年1月1日至2022年5月10日大连医科大学附属第二医院行血管内治疗术后闭塞血管成功再通的老年前循环大血管闭塞脑卒中患者123例,根据90 d内死亡与否分为死亡组21例和非死亡组102例。详尽收集2组基线资料、基线前循环Alberta卒中项目早期CT评分(ASPECTS)、脑卒中TOAST病因分型、实验室资料、入院时改良Rankin量表评分、美国国立卫生研究院卒中量表(NIHSS)评分、临床特征、取栓治疗的相关指标、术后指标,改良脑梗死溶栓(mTICI)分级以及术后90 d预后情况。结果死亡组中性粒细胞与淋巴细胞比值、纤维蛋白原、收缩压、舒张压、平均动脉压、手术时间、术后24 h NIHSS评分、术后颅内出血及术后症状性颅内出血比例明显高于非死亡组,ASPECTS、mTICI分级3级比例明显低于非死亡组,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,mTICI分级3级是术后90 d患者死亡的保护因素(OR=0.265,95%CI:0.076~0.922,P=0.037),入院舒张压及术后症状性颅内出血是术后90 d患者死亡的危险因素(OR=1.060,95%CI:1.011~1.112,P=0.016;OR=9.752,95%CI:2.554~37.230,P=0.001)。结论老年急性前循环缺血性脑卒中血管内治疗成功再通的死亡患者具有较高的入院舒张压、症状性颅内出血和较低mTICI分级3级。

Objective To analyze the risk factor of death within 90 d in the elderly patients with acute anterior circulation ischemic stroke who undergoing mechanical endovascular treatment with successful recanalization.Methods A retrospective study was conducted in 123 patients who were diagnosed with acute anterior circulation ischemic stroke and got successful recanalization after endovascular treatment in the Second Hospital of Dalian Medical University from January 1,2016 to May 10,2022.They were divided into death group(21 cases)and non-death group(102 cases)according to whether they died within 90 days.Detailed baseline data,pre-baseline cycle Alberta Stroke Project Early CT Score(ASPECTS),Acute Stroke(TOAST)etiology classification,laboratory indicators at admission,modified Rankin Scale(mRS)score at admission,National Institutes of Health Stroke Scale(NIHSS)score,clinical characteristics,endovascular treatment related indicators,postoperative indicators,Modified Treatment in Cerebral Ischemia Scale(mTICI)score and prognostic condition in 90 d postoperatively were collected and analyzed.Results Neutrophil to lymphocyte ratio(NLR),fibrinogen,systolic blood pressure,diastolic blood pressure,mean arterial pressure,endovascular operation time,postoperative NIHSS score within 24 h,postoperative intracranial hemorrhage,and symptomatic intracranial hemorrhage were significantly higher,while ASPECTS score and proportion of mTICI grade 3 were obvious lower in the death group than the non-death group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that mTICI grade 3 was an independent protective factor for death within 90 d(OR=0.265,95%CI:0.076-0.922,P=0.037),while diastolic blood pressure at admission(OR=1.060,95%CI:1.011-1.112,P=0.016)and symptomatic intracranial hemorrhage(OR=9.752,95%CI:2.554-37.230,P=0.001)were independent risk factors for death within 90 d in these patients.Conclusion The elderly patients who died in 90 d after endovascular treatment with successful recanalization due to acute anterior circulation ischemic stroke have higher diastolic blood pressure at admission,larger proportion of symptomatic intracranial hemorrhage and less proportion of mTICI grade 3.