伴有心房颤动的老年急性缺血性脑卒中患者血管内治疗预后转归

Prognosis in elderly stroke patients with atrial fibrillation after endovascular therapy

目的探讨伴有心房颤动的老年急性缺血性脑卒中患者血管内治疗的有效性及安全性。方法回顾性分析2017年1月至2021年12月于江苏省苏北人民医院神经内科行血管内治疗的老年急性缺血性脑卒中患者223例,根据患者是否伴有心房颤动分为心房颤动组97例和非心房颤动组126例,比较2组有效性及安全性指标差异。结果心房颤动组平均年龄高于非心房颤动组[(73.6±6.9)岁vs(70.9±7.1)岁,P=0.006],发病至穿刺时间短于非心房颤动组[(275.4±94.9)min vs(332.4±188.0)min,P=0.004],2组其他基线资料比较差异无统计学意义(P>0.05)。心房颤动组颅内出血比例高于非心房颤动组(43.3%vs 30.2%,P=0.043),但2组在90 d预后良好、再通良好、症状性颅内出血、90 d内死亡比例差异无统计学意义(P>0.05)。对可能影响血管内治疗颅内出血的相关因素进行单因素及多因素logistic分析,结果显示心房颤动不是血管内治疗颅内出血的独立危险因素,前循环闭塞、再通良好是颅内出血的独立危险因素。对可能影响血管内治疗预后不良的相关因素进行单因素及多因素logistic分析,结果显示高基线美国国立卫生研究院卒中量表(NIHSS)评分、血管内治疗再通不良、症状性颅内出血是血管内治疗预后不良的独立危险因素。结论心房颤动不影响急性缺血性脑卒中患者血管内治疗预后,同时也不增加症状性颅内出血风险。高基线NIHSS评分、血管内治疗再通不良、术后症状性颅内出血可能导致老年急性缺血性脑卒中患者血管内治疗预后不良的发生。

Objective To investigate the efficacy and safety of endovascular treatment in elderly stroke patients with atrial fibrillation.Methods A total of 223elderly patients with acute ischemic stroke due to large vessel occlusion undergoing endovascular treatment at Northern Jiangsu People's Hospital from January 2017to December 2021were enrolled retrospectively.The patients were divided into atrial fibrillation group(n=97)and non-atrial fibrillation group(n=126)according to complication of atrial fibrillation or not.The indicators related to efficacy and safety of endovascular treatment were compared between the two groups.Results The patients from the atrial fibrillation group had older age(73.6±6.9years vs 70.9±7.1years,P=0.006)and significantly shorter onset to puncture time(275.4±94.9min vs 332.4±188.0min,P=0.004).There were no statistical differences in other baseline data between the 2groups(P>0.05).Obviously higher proportion of intracranial hemorrhage was observed in the atrial fibrillation group than the non-atrial fibrillation group(43.3%vs 30.2%,P=0.043).No significant differences were seen in the incidences of 90-day good prognosis,good recanalization,symptomatic intracranial hemorrhage,and 90-day mortality between the two groups.Single factor and multivariate regression analyses indicated that atrial fibrillation was not,but anterior circulation occlusion and good recanalization were independent risk factor for intracranial hemorrhage after endovascular treatment.Higher baseline NIHSS scores,poor recanalization and symptomatic intracranial hemorrhage after endovascular treatment were independent risk factors for poor prognosis of patients after endovascular treatment.Conclusion The presence of atrial fibrillation has no effect on the prognosis of ischemic stroke patients after endovascular treatment,and does not increase the risk of symptomatic intracranial hemorrhage.Elderly stroke patients with higher baseline NIHSS scores,poor recanalization and postoperative symptomatic intracranial hemorrhage are more likely to have poor prognosis after endovascular treatment.