急性缺血性脑卒中机械取栓术后并发症状性颅内出血的影响因素

Influencing Factors for Symptomatic Intracranial Hemorrhage after Mechanical Thrombectomyin Acute Ischemic Strokepatients

目的探讨急性缺血性卒中(AIS)机械取栓术后并发症状性颅内出血(sICH)的影响因素,制定可能的预防措施,降低机械取栓术后并发sICH的发生率,提高手术的安全性,改善患者预后。方法回顾性分析2020年1月至2022年2月宁夏医科大学总医院,接受机械取栓的患者55例,根据患者术后有无并发sICH分为sICH组和非sICH组,进行多因素Logistic回归分析寻找AIS机械取栓术后并发sICH的影响因素。结果55例患者中sICH的发生率为21.8%(12/55),平均年龄(60.16±12.23)岁,90天内sICH组达到良好预后的患者低于非sICH组,90天内患者的总体死亡率为21.8%(12/55)。多因素Logistic回归分析显示:血流完全再通是sICH的保护因素,基线美国国立卫生研究院卒中量表(NIHSS)评分和发病至血管再通时间为sICH的独立危险因素。进一步绘制受试者工作特征(ROC)曲线,血流完全再通、基线NIHSS评分和发病至血管再通时间预测sICH的曲线下面积(AUC)分别为0.789、0.945、0.902。结论血流完全再通是AIS机械取栓术后并发sICH的保护因素,基线NIHSS评分、发病至血管再通时间则是危险因素,早期识别及预防危险因素具有重要意义。

Objective To explore the influencing factors and prophylactic measures for symptomatic intracranial hemorrhage after mechanical thrombectomyin patients with large vessel occlusion.We aimed to decline the symptomatic intracranial hemorrhage incidence rate in order to raisetechnical safety and improving patients outcomes.Methods We retrospectively reviewed 55 consecutive acute ischemic strokepatients data who underwent mechanical thrombectomy from January 2020 to February 2022 in General Hospital of Ningxia Medical University.All patients were divided into two groups based on the occurrence of symptomatic intracranial hemorrhage.We evaluated multiple predictive factors for the incidence of sICH using univariate and binary Logistic regression analysis.Results ICH was observed in 12 patients(21.8%),mean age(60.16±12.23)years old.Favorable neurological outcome was lower in patients with sICH than in patients without sICH,with the overall mortality being 21.8%(12/55)at 90 days after mechanical thrombectomy.Multivariate logistic regression analysis showed that complete recanalization was protective factor,NIHSS score before operation and onset-to-recanalization time were risk factors.The area under curvein NIHSS score before operation,onset-to-recanalization time,complete recanalization was 0.789,0.945,0.902.Conclusion NIHSS score before operation and onset-to-recanalization time are risk factorswhile complete recanalization is a protective factor forsymptomatic intracranial hemorrhage.Early identification and prevention are important.