急性前循环大血管闭塞患者血管内支架取栓术后死亡的影响因素分析:单中心回顾性研究

Analysis of influencing factors of death after endovascular stent thrombectomy in patients with acute anterior circulation large vessel occlusion:a single-center retrospective study

目的研究急性前循环大血管闭塞患者血管内支架取栓术后90 d内死亡的影响因素。方法回顾性连续纳入2017年10月至2020年12月于上海交通大学医学院附属仁济医院神经外科行血管内支架取栓的前循环大血管闭塞患者111例,根据术后90 d改良Rankin量表(mRS)评分进行分组,将其分为死亡组(mRS评分6分,25例)和存活组(mRS评分<6分,86例)。收集和比较两组患者的人口学特征(性别、年龄)、既往史(高血压病、糖尿病)、术前美国国立卫生研究院卒中量表(NIHSS)评分、发病时间、急性卒中Org 10172治疗试验(TOAST)分型、大血管闭塞位置(颈动脉、大脑中动脉)、手术资料(桥接动脉取栓)、去骨瓣减压术及其结局(症状性颅内出血)。采用单因素分析和多因素Logistic回归分析影响急性前循环大血管闭塞血管内支架取栓术后90 d内患者死亡的独立危险因素。结果(1)行血管内支架取栓的急性大血管闭塞患者死亡占比22.5%(25/111)。(2)死亡组患者年龄、NIHSS评分均高于存活组[70.0(65.0,80.5)岁比67.5(59.0,73.0)岁,Z=2.268;20.00(15.58,23.00)分比13.50(10.00,16.00)分,Z=4.633],糖尿病、行去骨瓣减压术、症状性颅内出血比例均高于存活组[44.0%(11/25)比10.5%(9/86),χ^(2)=13.749;48.0%(12/25)比5.8%(5/86),χ^(2)=26.578;20.0%(5/25)比1.2%(1/86)],血管成功再通比例低于存活组[76.0%(19/25)比93.0%(80/86),χ^(2)=5.821],组间差异均有统计学意义(均P<0.05);两组性别、高血压病、发病时间、是否桥接动脉取栓、大血管闭塞位置、TOAST分型的差异均无统计学意义(均P>0.05)。(3)多因素Logistic回归分析显示,年龄较大(OR=1.121,95%CI:1.046~1.201,P=0.001)、NIHSS评分较高(OR=1.227,95%CI:1.072~1.404,P=0.003)、去骨瓣减压术(OR=59.691,95%CI:7.939~448.800,P<0.01)为患者术后90 d死亡的独立危险因素。结论基于单中心数据,初步分析显示,高龄、高NIHSS评分与急性前循环大血管闭塞血管内支架取栓术后90 d内死亡独立相关,去骨瓣减压手术未能明显降低患者死亡风险。本研究结果有待未来进一步验证。

Objective To investigate the risk factors for the mortality within 90 days after endovascular stent thrombectomy of acute large vessel occlusion.Methods The clinical data of 111 patients with large vessel occlusion who underwent endovascular stent thrombectomy in the Department of Neurosurgery,Renji Hospital,Shanghai Jiaotong University School of Medicine from October 2017 to December 2020 were retrospectively collected.According to the modified Rankin scale(mRS)score 90 days after surgery,the patients were divided into the death group(mRS score of 6,25 cases)and the survival group(mRS score<6,86 cases).The demographic characteristics(gender,age),previous history(hypertension,diabetes),preoperative National Institutes of Health Stroke Scale(NIHSS)score,time of onset,and the trial of Org 10172 in acute stroke treatment(TOAST)classification,location of large vessel occlusion(carotid artery,middle cerebral artery),surgical data(bridging thrombectomy),decompressive craniectomy and outcome(symptomatic intracranial hemorrhage)of the two groups of patients were collected and compared.Univariate analysis and multivariate Logistic regression were used to analyze the independent risk factors for death in patients with acute anterior circulation large vessel occlusion within 90 days after endovascular stent thrombectomy.Results(1)The mortality rate of acute large vessel occlusion patients who underwent endovascular stent thrombectomy was 22.5%(25/111).(2)Age and NIHSS score in the death group were higher than those in the survival group(70.0[65.0,80.5]years old vs.67.5[59.0,73.0]years old,Z=2.268;20.00[15.58,23.00]min vs.13.50[10.00,16.00]min,Z=4.633),the proportions of diabetes,decompressive craniotomy and symptomatic intracranial hemorrhage were higher than those of survival group(44.0%[11.25]vs.10.5%[9/86],χ^(2)=13.749;48.0%[12/25]vs.5.8%[5/86],χ^(2)=26.578;20.0%[5/25]vs.1.2%[1/86]),the ratio of successful recanalization was lower than that of the survival group(76.0%[19/25]vs.93.0%[80/86],χ^(2)=5.821),with statistical significance(all P<0.05).There were no significant differences in gender,hypertension,onset time,bridging thrombectomy,large vessel occlusion location and TOAST classification between the two groups(all P>0.05).(3)Multivariate Logistic regression analysis showed older age(OR,1.121,95%CI 1.046-1.201,P=0.001),high NIHSS score(OR,1.227,95%CI 1.072-1.404,P=0.003),patients with decompressive craniectomy(OR,59.691,95%CI 7.939-448.800,P<0.01)were independent risk factors for postoperative mortality at 90 days.Conclusions Based on single-center data,preliminary analysis showed that advanced age and high NIHSS score were independently associated with death within 90 days after endovascular stent thrombectomy for acute anterior circulation large vessel occlusion,and decompressive craniectomy did not significantly reduce the risk of death in patients.The results of this study need further verification in the future.