急性颈内动脉末端闭塞患者早期预后影响因素及与颅内血供的关系

Influencing factors of early prognosis in patients with acute terminal occlusion of internal carotid artery and its relationship with intracranial blood supply

目的 探讨急性颈内动脉末端闭塞患者早期预后的影响因素及与颅内血供情况的关系。方法 回顾性纳入2018-01—2022-10于六安市人民医院就诊并行机械取栓治疗的急性颈内动脉末端闭塞患者108例,根据术后90 d预后情况分为良好组(41例)和不良组(67例)。采用单因素和多因素分析机械取栓术后早期预后的独立影响因素,评价其用于早期预后的预测效能。结果 单因素分析显示,年龄、基线NIHSS评分、机械取栓操作时间、合并房颤情况、末端闭塞类型及Willis环变异均与机械取栓术后早期预后不良有关(P<0.05);颈内动脉末端闭塞类型和Willis环变异情况均是机械取栓术后患者早期预后的独立影响因素(P<0.05)。Logistic多因素回归模型具有良好的拟合优度(Hosmer-Lemeshow χ^(2)=1.069,P>0.05)。利用Logistic预测概率、颈内动脉末端闭塞类型、Willis环变异情况对机械取栓术后患者的早期预后进行预测,约登指数分别为33.56%、25.09%、29.23%。结论 急性颈内动脉末端闭塞患者早期预后与颅内血供情况关系密切,其中急性颈内动脉末端T型闭塞和Willis环变异者预后更差,同时上述两种因素联合可准确预测患者早期预后的不良风险。

Objective To investigate the influencing factors of early prognosis in patients with acute terminal occlusion of internal carotid artery and its relationship with intracranial blood supply.Methods Totally 108 patients with acute end occlusion of internal carotid artery treated by mechanical thrombectomy were retrospectively chosen in the period from January 2018 to October 2022.All patients were divided into good group(41 cases)and poor group(67 cases)according to clinical prognosis of 90 d after operation.Single factor and multiple factor methods were used to analyze the independent influencing factors of early prognosis after mechanical thrombectomy,and the clinical effi-cacy of related influencing factors in predicting of early prognosis were evaluated.Results Univariate analysis showed that age,baseline NIHSS score,operation time of mechanical thrombectomy,combined atrial fibrillation,type of terminal occlusion and variation of Willis circle were associated with poor early prognosis after mechanical thrombectomy(P<0.05).The type of end occlusion of internal carotid artery and the variation of Willis ring were in-dependent factors influencing the early prognosis of patients after mechanical thrombectomy(P<0.05).Logistic multivariate regression model has good goodness of fit(Hosmer-Leishowχ2=1.069,P>0.05).The early prognosis of pa⁃tients after mechanical thrombectomy was predicted by Logistic prediction probability,the type of internal carotid ar⁃tery end occlusion,and the variation of Willis ring.The Yodon index was 33.56%,25.09%,and 29.23%,respective⁃ly.Conclusion The early prognosis of patients with acute terminal internal carotid artery occlusion is closely related to intracranial blood supply,and patients with acute terminal internal carotid artery T-type occlusion and circle of Willis variation have worsen clinical prognosis.The combination of above two factors can accurately predict the risk of poor early prognosis.